Assessment of Enalapril Effect on Inducing Anemia In Non-Azotemic Diabetic Patients

Background: Angiotensin converting enzyme inhibitors (ACEIs) are known to induce anemia following renal transplantation, dialysis and in renal failure patients. It seems that ACEIs cause anemia via inhibition of erythropoietin synthesis or inhibiting normal proliferation of early erythroid progenitors, which are normally stimulated by angiotensin converting enzyme. There are few reports on how ACEIs induce anemia in non-azotemic diabetic patients. We studied the effect of enalapril on inducing anemia in non-azotemic diabetic patients.
 Methods: This study included 94 diabetic non-azotemic patients (serum creatinine (sCr) ?1.5 mg/dl by jaffe reaction). Patients were divided into two groups, the first; with clinical proteinuria (P+ ) having a 24 hour urine protein ?300 mg or positive urine dipstick for protein, at least on two of three times tested, with an interval of 1 month and the second group without any signs of clinical proteinuria (P- ). Only 32 patients completed the course of study; 17 as P+ and 15 as P-. Patients in both groups received 10 mg enalapril daily; and every 3 months, the dose was doubled until the dose of 40 mg/day was reached, unless any side effects emerged. Hemoglobin concentration (Hb), sCr and serum potassium (K+) were also checked regularly. Data were analyzed using t-Student test, paired t test, and chi-square test. A p value < 0.05 was considered as significant.
 Results: Both groups of patients were matched from the standpoint of age and sex. The average baseline sCr in P+
 and P- groups were 0.8 ± 0.19 mg/dl and 0.8 ± 0.18 mg/dl respectively.( p = 0.97) After the study was completed, the average baseline sCr rose to 0.99±0.19 and 0.92±0.22 mg/dl in P+ and P- groups respectively. In P+ group, mean Hb was 14.1 ±1.30 g/dl and 13.9 ± 0.99g/dl before and after the study respectively.(p = 0.28) The same parameter for the P- group was measured as 14.1±1.00 and 12.9±3.30 before and after the study respectively.(Conclusion: This study shows that enalapril has no significant effect on inducing anemia in non-azotemic diabetic patients.
 Keywords: Enalapril, Anemia, Diabetes, Proteinuri

Early detection of patients at risk of acute renal failure after natural disasters

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Epidemiologic aspects of the Bam earthquake in Iran: the nephrologic perspective

Background: Acute renal failure is a serious, preventable, and potentially reversible midterm complication after mass disasters. In 2003, an earthquake struck Bam, Iran. This article studies the epidemiologic aspects of the earthquake from a nephrologic perspective. Methods: A questionnaire was sent to the reference hospitals. The resulting database of 2,086 traumatized patients hospitalized in the first 10 days was analyzed. Results: Mean age was 29.0 +/- 15.6 years. Compared with the resident population, the percentage of patients was lower among children and teenagers younger than 15 years and higher among young and middle-aged adults (P<0.001). There was no significant difference between mean ages of patients with acute renal failure and other patients. Time under the rubble was longer for patients with acute renal failure (6.2 +/- 4.1 versus 2.1 +/- 3.9 hours; P<0.001). These patients were hospitalized later (3.1 +/- 2.8 versus 1.5 +/- 1.7 days after the disaster; P<0.001) and longer (16.7 +/- 12.8 versus 12.5 +/- 11.3 days; P<0.001). Sepsis (11.6% versus 0.5%), disseminated intravascular coagulation (7.3% versus 0.3%), adult respiratory distress syndrome (9.1% versus 1.4%), fasciotomy (38.9% versus 1.9%), amputation (6.1% versus 0.5%), and death (12.7% versus 1.9%) were markedly more frequent among patients with acute renal failure (P<0.001 for all). Conclusion: Hospitalized patients were mostly young and middle-aged adults. Patients with acute renal failure were entrapped longer and hospitalized later and for longer periods. Medical complications, surgical procedures, and mortality were greater in the latter group. Early extrication and quick hospitalization with appropriate multidisciplinary care are cornerstones to prevent acute renal failure and Its subsequent mortality In earthquake conditions