Metformin improves diabetic kidney disease.

Implication for health policy/practice/research/medical education: Oxidative stress is caused by an imbalance in production of reactive oxygen and the biological ability to detoxify the reactive intermediates or repair the resulting damage. Herbal medicines commonly fight these complications with their antioxidant properties. However, it should be noted that herbal drugs extracts are abundant sources of polyphenols and these compounds are unstable and might be subjected to polymerization. Thus, it is essential to check that the observed biological properties are not due to polymerization of phenolic compounds

Sevelamer, a phosphate-binding resin with beneficial effect in diabetic kidney disease; a modern paradigm shift

The proportion of individuals diagnosed with diabetes mellitus is increasing throughout the world, which sequentially drives upward the global frequency of diabetic kidney disease (1, 2). Diabetes is a costly and deadly disease. Patients with diabetic kidney disease are at an increased risk for cardiovascular disease, premature death, and other severe diseases that ensue in increased health-care utilization and frequent hospitalizations (1, 2). In fact, type II diabetes mellitus is an ongoing medical dilemma that clinicians deal with on a daily basis

Aggressive jaw brown tumor in a 28-year-old man with long-lasted chronic kidney disease

Brown tumors are bony lesions triggered by rapid osteoclastic activity, which rarely involved jaws (1-3). In fact brown tumors or osteoclastomas are erosive bony lesions appearing as a complication of hyperparathyroidism. Renal osteodystrophy is the result of secondary hyperparathyroidism and is associated with various pathogenetic mechanisms, such as disorder of calcium-phosphate metabolism, increased parathyroid activity that lead to extreme concentrations of parathormone and impaired metabolism of vitamin D (1-7). We

The theme of the world diabetes day 2014; healthy living and diabetes; a nephrology viewpoint.

Annually, on November 14, the world diabetes day (WDD) is celebrated. WDD is a campaign led by the International Diabetes Federation (IDF) and its member associations throughout the world. It was created in 1991 by IDF and World Health Organization (WHO) in response to increasing concerns about the intensifying threat of diabetes worldwide. The WDD 2014 organization marks the first of a three-year (2014-16) emphasis on "healthy living and diabetes". Replacement of whole grain and cereal-based foods with refined grains in diet planning could be an operative and practical strategy in type II diabetic patients. This strategy beyond the development of glycemic control, leads to more benefits for management of other features of diabetes, diminution of diabetes-induced metabolic disorders, and prevents long-term complications especially diabetic kidney disease and cardiovascular disease

Causes of pleural effusion in long-term hemodialysi s

Background and Objective: Pleuropulmonary complications, such as pleural effusion (PE) are encountered with an increased frequency among patients with end stage renal disease. Subjects and Methods: In the cross-sectional and prospective study we evaluated 253 patients who had received long- term hemodialysis between 2007 September and 2008 October for better understanding the incidence and causes of PE in this population. Results: The incidence of pleural effusion was 25 % (n= 63, mean age 48.09 ± 1.39 years, male to female ratio approximately 1.1). 66.6 % of the patients (n= 42) had transudative PE and 33.4% (n= 21) had exudative PE. Transudative PE resulted from heart failure in 64.3% (n= 27), hypervolemia in 33.3% (n= 14) and cirrhosis in 2.4% (n= 1). Parapneumonic effusion (n= 6), TB (n= 5), uremic pleurisy (n= 4), malignancy (n= 2), unknown (n= 2) and SLE (n= 1) accounted for causes of exudative PE. Conclusion: Pleural effusion is a common complication in hospitalized patients receiving long–tern hemodialysis. Since heart failure, hypervolemia and uremic pleurisy were the most common causes of pleural effusion, this problem should not be considered an obstacle in renal transplant recipients

The effect of gabapentin on muscle cramps during hemodialysis: A double-blind clinical trial

Hemodialysis‐associated muscle cramps (HAMC) are a common complication during hemodialysis (HD) sessions. A number of pharmacologic agents have been evaluated to prevent and or diminish HAMC; however, none of them has an established role. To the best of our knowledge, this is the first study to evaluate the possible effect of gabapentin on HAMC. In a double-blinded clinical trial, we compared the possible effect of gabapentin with a placebo in prevention and or diminishing episodes of HAMC in HD patients who had experienced frequent intradialytic muscle cramps. At first, placebo was given before each dialysis session for four weeks and then, after a two-week washout period, 300 mg of gabapentin was given before each dialysis session for four weeks to verify the effect of gabapentin on HAMC. Overall, 15 patients (seven men and eight women; mean age, 52.02 years) with frequent intradialytic muscle cramps were enrolled in the study. The incidence of symptomatic muscle cramp decreased in the gabapentin group compared with the placebo group, with a significant difference between them (P = 0.001). The intensity of muscle cramps also decreased in the gabapentin group (P = 0.001). There was no significant association between HAMC in male and female patients (P = 0. 397), mean age of HD patients (P = 0.226) and cause of end-stage renal disease (P = 0.551). According to the results of our study, gabapentin prescription before each HD session significantly reduced the frequency and the intensity of muscle cramps during HD without any major side-effects

Cisplatin Induced Nephrotoxicity

Cisplatin is a potent chemotherapy agent which is used to treat a broad spectrum of solid cancers. However, its clinical use is limited due to its nephrotoxicity with a decline in the glomerular filtration rate that occur in 15-30% of patients. Multiple mechanisms contribute to renal dysfunction following exposure to cisplatin include tubular epithelial cell toxicity, vasoconstriction in the renal microvasculature, and increase the expression of proinflammatory cytokines. The most important manifestations of cisplatin nephrotoxicity are non oliguric acute renal failure (ARF) which can be progressive, hypomagnesemia, fanconi-like syndrome, and anemia. An increasing risk of ARF is associated with higher doses of cisplatin, previous cisplatin chemotherapy, underlying kidney dysfunction, and the concomitant use of other nephrotoxic agents. The standard approach to prevent cisplatin-induced nephrotoxicity is the administration of lower doses of cisplatin in combination with the administration of full intravenous isotonic saline before and after cisplatin administration. Although a number of pharmacologic agents including sodium thiosulfate, N-acetylcysteine, theophylline and glycine have been evaluated for prevention of nephrotoxicity, none have proved to have an established role, thus, additional clinical studies will be required to confirm their probable effects

Comparison of survival in patients with end-stage renal disease receiving hemodialysis versus peritoneal dialysis

Although the life expectancy of patients with end-stage renal disease (ESRD) has improved in recent years, it is still far below that of the general population. In this retrospective study, we compared the survival of patients with ESRD receiving hemodialysis (HD) versus those on peritoneal dialysis (PD). The study was conducted on patients referred to the HD and PD centers of the Emam Khomini Hospital and the Aboozar Children′s Hospital from January 2007 to May 2012 in Ahvaz, Iran. All ESRD patients on maintenance HD or PD for more than two months were included in the study. The survival was estimated by the Kaplan-Meier method and the differences between HD and PD patients were tested by the log-rank test. Overall, 239 patients, 148 patients on HD (61.92%) and 91 patients on continuous ambulatory PD (CAPD) (38.55%) with mean age of 54.1 ± 17 years were enrolled in the study. Regardless of the causes of ESRD and type of renal replacement therapy (RRT), one-, two- and three-year survival of patients was 65%, 51% and 35%, respectively. There was no significant difference between type of RRT in one- (P-value = 0.737), two- (P-value = 0.534) and three- (P-value = 0.867) year survival. There was also no significant difference between diabetic and non-diabetic patients under HD and CAPD in the one-, two- and three-year survival. Although the three-year survival of diabetic patients under CAPD was lower than that of non-diabetic patients (13% vs. 34%), it was not statistically significant (P-value = 0.50). According to the results of the current study, there is no survival advantage of PD during the first years of initiation of dialysis, and the one-, two- and three-year survival of HD and PD patients is also similar