INCIDENCE AND RISK FACTORS OF NEW ONSET DIABETES MELLI-TUS AMONG TRANSPLANTED RENAL ALLOGRAFT RECIPIENTS

Abstract &nbsp;&nbsp; INTRODUCTION: Post-transplant diabetes mellitus (PTDM) contributes to the risk for cardiovascular disease and infection, reducing graft and patient survival. This study was conducted to identify incidence and risk factors for development of PTDM. &nbsp;&nbsp; METHODS: We studied 50 non-diabetic adult dialyzed patients awaiting renal transplantation prospectively. Oral glucose tolerance test () was performed pre- and post-transplantation. The relation of age, weight (BMI), dialysis modality, family history of diabetes, duration of dialysis was assessed with occurring PTDM. &nbsp;&nbsp; RESULTS: Based on 1, 13 patients had unknown Diabetes Mellitus; however after transplantation only 9 of them had same results. Based on 2 6(16.22%) patients had actually PTDM. Age of patients with PTDM were significantly higher than those with normal test (43&plusmn; 17 versus 31&plusmn; 11 year old) (P&lt;0.05). There was significant relation between duration of dialysis with PTDM (P&lt;0.05), as normal was seen in 85.2% patients that dialyzed less than 1 year. There was no significant relation among dialysis modality and family history of diabetes and BMI with PTDM (P&gt;0.05). &nbsp;&nbsp; CONCLUSION: Risk factors for diabetes in our study were age and duration of dialysis before transplantation. Then identifying them might allow modification of post transplant immunosuppressant with nondibetogenic agents in high risk patients. &nbsp; &nbsp;&nbsp; Keywords: post-transplant diabetes mellitus, oral glucose tolerance test, renal transplantation. &nbsp;</p

Effect of Renal Artery Stenting on Blood Pressure, Glomerular Filtration Rate and Left Ventricular Mass in Hypertensive Patients with Severe Atherosclerotic Renal Artery Stenosis

Background Many small trials showed a significant improvement in blood pressure following renal artery stenting in patients with severe atherosclerotic renal artery stenosis, but data on renal function improvement is more conflicting. Recently, few trials have been conducted to evaluate the effect of this procedure on Left Ventricular Mass (LVM) and Left Ventricular Mass Index (LVMI). Objectives The aim of this study is to determine the effect of renal artery stenting on Blood Pressure, estimated Glomerular Filtration Rate (eGFR), Left Ventricular Mass (LVM), and Left Ventricular Mass Index (LVMI) in patients with severe atherosclerotic renal artery stenosis. Methods This is a prospective interventional study performed on forty patients with ischemic heart disease and medication resistant hypertension, who had severe (≥ 70%) atherosclerotic renal artery stenosis and underwent renal artery stenting. Blood pressure, LVM, LVMI and eFGR before renal artery stenting and after six months were assessed in these patients. Results There were significant reduction in systolic blood pressure (from 175.50 ± 17.28 mmHg to 137.30 ± 13.21 mmHg) (P < 0.001), and diastolic blood pressure (from 103.45 ± 8.91 mmHg to 84.30 ± 7.33 mmHg) (P < 0.001). Also, there were significant decrease in LVM (from 307.73 ± 108.13 g to 259.34 ± 92.17 g) (P = 0.004) and LVMI (from 174.70 ± 58.26 to 148.01 ± 49.77) (P = 0.004). LVM reduction was independent of SBP and DBP reduction (P = 0.376 and P = 0.196, respectively). Conclusions Renal artery stenting reduces Blood pressure and leads to regression of LVM independent of blood pressure reduction. Regardless of baseline eGFR, our study failed to find a significant increase in glomerular filtration rate

Effect of oral granisetron in uremic pruritus

Background : Renal itch is a relatively common and distressing problem for patients with chronic renal failure. Granisetron, is a potent and selective inhibitor of 5-HT3 receptors. There have been some studies about the effect of ondansetron in uremic pruritus and one case report has recently described relief of renal itch with granisetron. Aims : To evaluate the effect of Granisetron on uremic pruritus in Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis (HD) patients. Methods: To study the prevalence of uremic pruritus, patients on CAPD and HD were asked to complete a pruritus questionnaire.Their replies were scored based on numerical scales. Pruritus was graded, according to the total points for each patient, as mild, moderate or severe. Fourteen patients with moderate to severe pruritus were enrolled in the trial. During treatment, patients received granisetron (1 mg tablet twice a day P.O), for a period of 1 month. They were asked to score the severity of pruritus twice a day. Results : Seventy seven percent of the patients responded to the treatment and at 1 st , 2 nd and 4 th week the mean values of the pruritus scores were 23, 16 and 8 points respectively. Before starting treatment the score was 31 points ( P =0.03). Weekly clinical and laboratory examination showed no important side effects. Conclusion : Granisetron might be an effective, safe and well tolerated drug for the treatment of uremic pruritus

Thyroid Hormone Changes in Early Kidney Transplantation and Its Correlation with Delayed Graft Function

Introduction: Thyroid hormones affect kidney function and may alter with changes in kidney function, as well. We evaluated changes in serum levels of triiodothyronine (T3), thyroxin (T4), and thyroid-stimulating hormone (TSH) early after kidney transplantation and their relationship with delayed graft function (DGF). Materials and Methods: Fifty-five consecutive kidney allograft recipients were enrolled in the study. Serum levels of T3, T4, and TSH were measured on the day before transplantation, and also on posttransplant days 1, 3, 7, 14, and 21. Results were compared between patients with a normal allograft function and those with DGF. Results: The mean T3 level decreased from 110.41 ± 49.79 ng/dL before transplantation to 80.78 ± 51.42 ng/dL on the 1st day after transplantation (P = .04), while T4 reduction reached a significant level on the 3rd day after transplantation (8.27 ± 3.27µg/dL to 5.50 ± 2.57 µg/dL, P = .004). Patients with DGF experienced a significantly greater decrease in the serum level of T3 at the end of the 1st week after transplantation compared with patients with normal kidney function (P = .02). This significant decrease in T3 continued until the end of the 2nd week. Serum levels of T4 reduced comparably in the two groups, until the end of the 1st week, when it showed a significantly more reduction in the patients with DGF (P = .04). Conclusion: Both T3 and T4 reduced early after kidney transplantation, and this reduction was significantly more prominent in those with DGF. This is compatible with a consequence rather than a cause of DGF, explained in the setting of sick euthyroid syndrome