Catastrophic antiphospholipid syndrome presented with sudden renal failure and history of long-lasting psychosis and hypertension in a 42 years old women

Implication for health policy/practice/research/medical education: The catastrophic variant of the antiphospholipid syndrome (CASP) is defined as a potential life-threatening variant of antiphospholipid syndrome (APS), which is characterized by multiple small-vessel thrombosis that can lead to organ failure especially renal deterioration. This vaso-occlusive nephropathy mainly affects arterioles, interlobular arteries and glomerular tufts. However, interstitial area and tubules maybe subsequently involved. © 2013, Society of Diabetic Nephropathy Prevention. All rights reserved

Contrast induced nephropathy; recent findings.

Contrast induced nephropathy is one cause of acute renal failure. Contrast induced nephropathy is the third most common cause of hospital-acquired acute renal failure. The incidence of contrast induced nephropathy in the general population is 0.6% to 2.3%, but when focusing on specific high-risk patients the incidence can increase to more than 40%. Studies suggest that intravenous hydration is the most effective strategy to prevent contrast induced nephropathy. Hydration is inexpensive and is usually risk-free. Administration of optimal fluids before and after the contrast procedure allows for increased urine output and improved outcomes

Renin-angiotensin system blockage for reduction of plasma adiponectin level in maintenance hemodialysis patients: A randomized controlled trial

Introduction. Plasma adiponectin level is markedly increased among patients on hemodialysis. This investigation aimed to evaluate the relationship between renin-angiotensin system blockade and serum adiponectin concentration in nondiabetic patients on hemodialysis. Materials and Methods. This randomized double-blind controlled trial was conducted on a group of nondiabetic patients on regular hemodialysis. The first group received losartan, 12.5 mg twice per day for the 1st week, 25 mg twice per day during the 2nd week, and 75 mg/d from the 3rd week to the end of the 16th week. Patients of the control group received placebo. Blood samples from all of the patients were collected at the beginning and at the end of the study to measure serum adiponectin. Results. Seventy-three hemodialysis patients were divided randomly into the losartan group (40 patients) and the control group (33 patients). The mean adiponectin level in all of the patients was 10.6 ± 3.9 μg/mL. A significant decrease of serum adiponectin level was observed after 4 months of treatment with losartan (8.86 ± 3.43 μg/mL for losartan group versus 10.71 ± 3.94 μg/mL for the control group; P = .04). None of the patients had a serum potassium value greater than 5 mg/dL or hypotension during the intervention. There was no significant difference in serum potassium levels between the two groups. Conclusions. The decrease in serum adiponectin level in nondiabetic patients on regular hemodialysis by losartan might offer a potential protective approach in these patients. Mechanisms responsible for this reduction remain to be investigated. © 2016, Iranian Society of Nephrology. All rights reserved

Correlation of serum parathyroid hormone with pulmonary artery pressure in non-diabetic regular hemodialysis patients

Abstract Introduction: Pulmonary artery hypertension in end-stage renal disease is associated by significantly increased morbidity and mortality. Serum parathormone may increase among patients on hemodialysis and influence various organs. Objectives: This study sought to find the association of serum parathormone level and pulmonary artery pressure in a group of non-diabetic patients on regular hemodialysis. Materials and Methods: This prospective investigation was conducted in the hemodialysis section of Shahrekord University of Medical Sciences in 2013. Doppler echocardiography were used to assess pulmonary artery pressure. Pulmonary arterial hypertension is defined as systolic PAP≥35 mm Hg at rest. Serum parathormone was measured by ECL method. Results: Sixty-five, non-diabetic hemodialysis patients were studied. Mean (±SD) of age of the patients was 56.35±20.41 years. Mean (±SD) of iPTH was 251.55±97.27 pg/ml. In this study, a significant positive association of serum iPTH with pulmonary artery pressure in patients was seen (r=0.27, p=0.029). Conclusion: In the present study, we detected a significant positive association of serum parathyroid hormone with pulmonary artery pressure of hemodialysis patients however, our observations, warranting further investigations to evaluate the clinical aspect of the association of serum PTH with pulmonary artery pressure. Keywords: End-stage renal disease, Hemodialysis, Pulmonary hypertension, Parathormone Please cite this paper as: Heidari M, Mardani S, Baradaran A. Correlation of serum parathyroid hormone with pulmonary artery pressure in non-diabetic regular hemodialysis patients. J Parathyr Dis 2014; 2(2): 78-80. Copyright © 2014 The Author(s); Published by Nickan Research Institute. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Evaluating the liver toxicity of hydroalcoholic extract of momordica charantia in male balb/C mice

Background: Momordica charantia (bitter melon) is known for its hypoglycemic effect and widely used for the treatment of diabetes. This study other than evaluating plant antioxidant and its effect on blood antioxidant capacity, examined the effects and safety of bitter melon fruit in laboratory mice. Methods: 70 male mice (2-3 weeks old, body weight 25-30 g) were randomly divided into 7 groups. The mice were acclimatized to laboratory conditions for 7 days and at day 8, they were dosed intraperitoneally (single dose groups: 0, 100, 500, 1000, 2000, 4000 mg/kg and the group which was treated for 7 days: 500 mg/kg/day). Mice were then observed for 72 hours before they were scarified, immediately livers were taken for histology. Serum samples were assayed for liver functions [alkaline phosphatase (ALT), serum glutamic-pyruvic transaminase (SGPT) and serum glutamic oxaloacetic transaminase (SGOT)]. Blood and bitter melon antioxidant activity was measured. Findings: All single dose groups showed normal behavior after the dosing and no statistical changes were observed in all liver parameters including for SGOT, SGPT or ALP (P > 0.05). Lab data were shown as follow: ALP = 204.7 ± 88.0, SGOT = 180.8 ± 76.0, SGPT = 80.6 ± 54.0. Histological examinations revealed normal organ structures. Antioxidant activity of bitter melon was 68% and blood antioxidant activity was 564 μmol/ml. Conclusion: Doses up to 4000 mg/kg did not have any effects on the mice liver functions nor its histology. We suggest more studies with different doses. © 2016, Isfahan University of Medical Sciences(IUMS). All rights reserved

Herbal medicine and diabetic kidney disease.

Implication for health policy/practice/research/medical education Diabetic kidney disease is the leading cause of end-stage renal failure worldwide, however current treatments remain suboptimal. Recently various plants have shown beneficial effects not only on kidney function in diabetes mellitus, but also on kidney toxicities induced by some drugs or toxins. The active substances recognized in these plants include polysaccharides, flavonoids, xanthones and peptide

Serum magnesium in association with parathyroid hormone levels in routine hemodialysis patients

Abstract Introduction: The homeostasis of magnesium (Mg) is perturbed in chronic kidney disease. It has been supposed that plasma Mg has a principal role to regulate the secretion of parathyroid hormone (PTH). Plasma Mg is capable of modulating secretion of PTH. Recent investigations showed that low serum Mg levels in patients with kidney disease have been linked to increased mortality. Objectives: The aim of this study was to determine the relationship between serum Mg and PTH levels in hemodialysis patients. Patients and Methods: This cross-sectional study was conducted on 56 hemodialysis patients in hemodialysis center of Hajar hospital of Shahrekord in 2015. Regular hemodialysis patients who had at least three months history of dialysis were enrolled to the study. The serum levels of Mg, calcium, phosphorus, intact PTH (iPTH), alkaline phosphatase, albumin and bicarbonate were measured. Results: In this study, 61.5% of the 52 patients were male. Mean ± standard deviation (SD) of patients’ age was 60.5 ± 17.7 years with median of 63 years old. The average duration of dialysis was 44±39.5 months (median 36 months). Additionally the dialysis dose was 517 ± 479 weeks (median; 414 weeks). Mean ± SD of serum iPTH and Mg were 360.1 ± 238.2 pg/mL and 2.2 ± 0.2 mg/mL respectively. In this study we found a significantly positive correlation of iPTH with serum Mg levels (r=0.28, P=0.04). Conclusion: This study shows impact of Mg on parathormone secretion. Our findings require further investigations with larger and multicentric studies. Please cite this paper as: Fooladgar M, Malekpour A, Asgari-Savadjani S, Mardani S. Serum magnesium in association with parathyroid hormone levels in routine hemodialysis patients. J Parathyr Dis. 2018;6(1):13-15. DOI: 10.15171/jpd.2018.05. Copyright © 2018 The Author(s); Published by Nickan Research Institute. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work i

A comparative study on the effect of calcitriol and cinacalcet on hyperparathyroidism in hemodialysis patients; a double-blinded randomized clinical trial

Introduction: Chronic kidney disease (CKD) has lots of complication like calcium and phosphate metabolism disorders, hyperparathyroidism, vitamin D deficiency and metabolic acidosis. Objectives: The aim of this study was to determine and compare the effect of calcitriol and cinacalcet on hyperparathyroidism in hemodialysis patients due to end-stage renal disease (ESRD). Patients and Methods: This study was a double-blinded randomized clinical trial, which was conducted on 60 hemodialysis patients in 2017-2018. The patients were randomly assigned to two groups of 30 patients, which one group was treated with cinacalcet and the other group was treated with calcitriol. During this study, phosphorus, calcium and iPTH were measured. Results: The results showed that in the group treated with cinacalcet, the amount of calcium t(22)=0.294, P > 0.05 and the amount of phosphorus t(22)=1.87, P > 0.05 did not change significantly while iPTH values before and after the study had statistically significant difference t(22)=4.37, P 0.05). Calcium changes in the cinacalcet group compared to the calcitriol group t (47) =-1.14, P > 0.05 and also, the amount of phosphorus changes t (47) =-1.022, P > 0.05 was not statistically significant. The iPTH changes were not statistically significant between the two groups however iPTH in the calcitriol group was higher than the cinacalcet group t (47) =-1.13, P > 0.05. Conclusion: In contrast to calcitriol, cinacalcet significantly reduced iPTH and did not significantly change calcium and phosphorus levels. Trial Registration: The trial was registered by Iranian Registry of Clinical Trials (IRCT) (identifier: IRCT20190702044076N1; https://en.irct.ir/trial/40547, Ethical code# IR.SKUMS.REC.1397.026)

Comparison of high-flux and low-flux hemodialysis filters on hemodialysis adequacy in under-hemodialysis patients with end-stage renal disease

Abstract Background: Hemodialysis is the most common alternative therapy in chronic renal failure and inadequate dialysis increases the mortality of patients; thus, the dialysis adequacy in these patients is important. This study aimed to compare the adequacy if hemodialysis high-flux and low-flux filters in Hospital Dialysis Centers of Shahrekord University of Medical Sciences, Iran, and assess its relation to other indices for patients with chronic and end-stage renal disease (ESRD). Methods: In a randomized clinical trial, 42 patients were performed with low-flux and high-flux filters. So, the patients with end-stage chronic kidney disease, with the rate of ultrafiltration of more than 3 liters, in the two cross groups underwent hemodialysis with high- and low-flux filters in 2 months. The indicators for measuring the Kt/V in each dialysis and other lab indices at the beginning and the end of each month were measured and compared using SPSS software. Findings: At the end of the intervention, significant difference in adequacy of dialysis was observed between the two groups of high- and low-flux filtration. Although, both groups of patients had adequacy of dialysis in terms of defined standards, but the findings showed that Kt/V in hemodialysis significantly was lower in high-flux group (P = 0.013). Conclusion: This study showed that the high-flux filters in higher volumes of 3 liters of ultrafiltration, increases the average dialysis adequacy more than the low-flux filters. We suggest future studies to assess the impact of long-term use of high-flux filters on dialysis efficacy, improved quality of life and reduced hospitalization rate in hemodialysis patients and its effect on reducing healthcare costs; patients are thereby cost-benefited in using high-flux filters for long term. Keywords: End-stage renal disease, Dialysis, Ultrafiltratio