Acute interstitial nephritis in the south of Iran; an observational study

Background: Acute interstitial nephritis (AIN) is an emerging cause of acute kidney injury (AKI) during the recent years. Objectives: There is no data about prevalence, causes, clinical manifestation and outcomes of AIN in our region. Hence, in this study we aimed to find the prevalence of AIN and describe the causes, clinical presentation, and the outcome of AIN in the native kidney biopsies. Patients and Methods: We reviewed 934 native kidney biopsies from 2006 to 2014 and collected the data of patients with the diagnosis of AIN including medical history, clinical findings, para-clinical data, pathologic findings, treatment and outcomes. Results: Prevalence of AIN in our center during 2006 to 2014 was 2.5% of all renal biopsies. The common cause of AIN in our study was drugs. Of those patients admitted to hospital due to AIN, 17 patients (70.8%) received corticosteroid, five of them (29.4%) received pulse of corticosteroid, and 12 patients (70.6%) received oral drug. Around, 54.2% of the patients had hemodialysis during admission. Eight patients had received both dialysis and corticosteroid. Two of them (8.3%) remained on dialysis and 8 (33.3%) developed chronic kidney disease, but 14 (58.3%) patients recovered. Conclusions: The prevalence of AIN in our study is comparable to other studies and we found the great impact of medications on development of AIN

Protective Effect of Edaravone Against Cyclosporine-Induced Chronic Nephropathy Through Antioxidant and Nitric Oxide Modulating Pathways in Rats

Background: Cyclosporine A (CsA) is an immunosuppressant with therapeutic indications in various immunological diseases; however, its use is associated with chronic nephropathy. Oxidative stress has a crucial role in CsA-induced nephrotoxicity. The present study evaluates the protective effect of edaravone on CsA-induced chronic nephropathy and investigates its antioxidant and nitric oxide modulating property. Methods: Male Sprague-Dawley rats (n=66) were distributed into nine groups, including a control (group 1) (n=7). Eight groups received CsA (15 mg/kg) for 28 days while being treated. The groups were categorized as: • Group 2: Vehicle (n=10) • Groups 3, 4, and 5: Edaravone (1, 5, and 10 mg/kg) (n=7 each) • Group 6: Diphenyliodonium chloride, a specific endothelial nitric oxide synthase (eNOS) inhibitor (n=7) • Group 7: Aminoguanidine, a specific inducible nitric oxide synthase (iNOS) inhibitor (n=7) • Group 8: Edaravone (10 mg/kg) plus diphenyliodonium chloride (n=7) • Group 9: Edaravone (10 mg/kg) plus aminoguanidine (n=7) Blood urea nitrogen and serum creatinine levels, malondialdehyde, superoxide dismutase, and glutathione reductase enzyme activities were measured using standard kits. Renal histopathological evaluations and measurements of eNOS and iNOS gene expressions by RT-PCR were also performed. Data were analyzed using one-way analysis of variance (ANOVA) followed by Tukey’s test (SPSS software version 18.0). Results: Edaravone (10 mg/kg) significantly attenuated CsA-induced oxidative stress, renal dysfunction, and kidney tissue injury. Aminoguanidine improved the renoprotective effect of edaravone. Edaravone reduced the elevated mRNA level of iNOS, but could not alter the level of eNOS mRNA significantly. Conclusion: Edaravone protects against CsA-induced chronic nephropathy using antioxidant property and probably through inhibiting iNOS gene expression

Electron microscopy study of 496 cases of lupus nephritis: A single-center experience

Introduction: Renal involvement is seen in about 40-82 of systemic lupus erythematosus (SLE) Asian patients. The exact diagnosis and classification of lupus nephritis are important for treatment and prognosis. This study aimed to investigate the value of electron microscopy (EM) in the diagnosis and classification of lupus nephritis compared with light microscopy. Method: In this cross-sectional referral-center 16-year study of lupus nephritis, the final diagnosis was based on the EM study. Primary light microscopy findings were compared with EM diagnosis. Moreover, Immunofluorescence patterns distribution was assessed. Results: From 496 patients diagnosed with lupus nephritis based on EM, 225(45.4) of patients were categorized in class IV, followed by 98(19.7), 93(18.8), 46(9.3), and 14(2.8) who were categorized into classes of II, III, V, and VI respectively. Only 1(0.2) patient belonged to class I, and 19(3.8) cases were diagnosed with mixed two classes. Using EM was essential for diagnosing 25.6 of cases taking the correct classification by light microscopy into account; however, disregarding correct classification, this could change to a 7.4 contribution rate of EM. The most common cause of misdiagnosis, disregarding incorrect classification, was inadequate or wrong tissue. Positive associations were detected between tubular atrophy and interstitial fibrosis of both electron and light microscopy with different classes (P < 0.001). Conclusion: While light microscopy is highly accurate for diagnosing lupus nephritis regardless of correct classification, EM contributes substantially to the correct classification of lupus nephritis types. © The Author(s) 2021