Nasri, H.

Rafieian-Kopaei, M.

Rafieian-Kopaei, Mahmoud

Nasri, Hamid

Elsevier - Publisher Connector 

Comment on: Is the renoprotective effect of erythropoietin in chronic kidney disease a myth? 

shahrekord university of medical scinces

Journal of the Formosan Medical Association (2014) 113, 62Available online at www.sciencedirect.comjournal homepage: www.j fma-onl ine.comLETTER TO THE EDITORComment on: Is the renoprotective effect oferythropoietin in chronic kidney disease amyth?Dear Editor,We read with great interest the article by Yeh and col-leagues,1 entitled “Is the renoprotective effect of erythro-poietin in chronic kidney disease a myth?”, published in theesteemed Journal of the Formosan Medical Association. Inthis article, they discussed the evidence in favor of therenoprotective potential of erythropoietin in patients withchronic kidney disease. However, they suggested furtherclinical studies to decide when to start erythropoietin treat-ment and determine the optimal erythropoietin dosage forslowing disease progression in patients with chronic kidneydisease. More importantly, they speculated that the appli-cation of erythropoietin for kidney protection might need tobe prior to that for erythropoiesis.1 In this context, we wouldlike topresent a fewpoints about the kidney protective effectof erythropoietin. In a study of 40maleWistar rats, performedto evaluate the ameliorative effect of erythropoietin ontubular cells, we found that erythropoietin was able to pre-vent the increase in serum creatinine and blood urea nitrogenlevels. Furthermore, coadministration of gentamicin anderythropoietin effectively reduced the kidney tissue damageinduced by gentamicin, compared to the control group. Ourinvestigation disclosed the kidney protective effect oferythropoietin, when the drug was given in combination withgentamicin. However, the protective properties of erythro-poietin were evident even when the drug was applied afterinduction of tubular damage by gentamicin, and it was stilleffective after tissue injury.2 This indicates that erythropoi-etin may have a curative effect, in addition to its preventiveproperties.2 Thus, erythropoietin is a promising kidney pro-tective agent that can prevent, ameliorate, or attenuatetubular damage induced by gentamicin or other nephrotoxicagents such as cyclosporine.3,4 Various studies have alsoshown the beneficial effect of erythropoietin on renal allo-graft survival. It seems reasonable that we start erythropoi-etin prior to erythropoiesis, as Yeh et al1 described in theirDOI of original article: http://dx.doi.org/10.1016/j.jfma.2013.05.005.0929-6646/$ - see front matter Copyright ª 2013, Elsevier Taiwan LLChttp://dx.doi.org/10.1016/j.jfma.2013.05.006article; however, the curative effect of this drug should alsobe considered. In this regard, to better understand therenoprotective properties of erythropoietin, more experi-mental or clinical studies are suggested.Conflicts of interestThe authors have no conflicts of interest relevant to thisarticle.References1. Yeh PY, Liao FL, Lin SL. Reply to comment on: Is the renopro-tective effect of erythropoietin in chronic kidney disease amyth? J Formos Med Assoc 2013;113:63e4. http://dx.doi.org/10.1016/j.jfma.2013.03.005.2. Rafieian-Kopaei M, Nasri H, Nematbakhsh M, Baradaran A,Gheissari A, Rouhi H, et al. Erythropoietin amelioratesgentamicin-induced renal toxicity: a biochemical and histopath-ological study. J Nephropathol 2012;1:109e16.3. Kadkhodaee M. Erythropoietin; bright future and new hopes foran old drug. J Nephropathol 2012;1:81e2.4. Gobe GC, Morais C, Vesey DA, Johnson DW. Use of high-doseerythropoietin for repair after injury: a comparison of out-comes in heart and kidney. J Nephropathol 2013;2:154e65.Mahmoud Rafieian-KopaeiMedical Plants Research Center, Shahrekord University ofMedical Sciences, Shahrekord, IranHamid Nasri*Department of Nephrology, Division of Nephropathology,Isfahan University of Medical Sciences, Isfahan, Iran*Corresponding author. Department of Nephrology,Division of Nephropathology, Isfahan University of MedicalSciences, Isfahan, Iran.E-mail address: hamidnasri@med.mui.ac.ir25 April 2013& Formosan Medical Association. All rights reserved.

Comment on: Is the renoprotective effect of erythropoietin in chronic kidney disease a myth?

Journal of the Formosan Medical Association (2014) 113, 62Available online at www.sciencedirect.com
journal homepage: www.j fma-onl ine.comLETTER TO THE EDITORComment on: Is the renoprotective effect of
erythropoietin in chronic kidney disease a
myth?
Dear Editor,
We read with great interest the article by Yeh and col-
leagues,1 entitled “Is the renoprotective effect of erythro-
poietin in chronic kidney disease a myth?”, published in the
esteemed Journal of the Formosan Medical Association. In
this article, they discussed the evidence in favor of the
renoprotective potential of erythropoietin in patients with
chronic kidney disease. However, they suggested further
clinical studies to decide when to start erythropoietin treat-
ment and determine the optimal erythropoietin dosage for
slowing disease progression in patients with chronic kidney
disease. More importantly, they speculated that the appli-
cation of erythropoietin for kidney protection might need to
be prior to that for erythropoiesis.1 In this context, we would
like topresent a fewpoints about the kidney protective effect
of erythropoietin. In a study of 40maleWistar rats, performed
to evaluate the ameliorative effect of erythropoietin on
tubular cells, we found that erythropoietin was able to pre-
vent the increase in serum creatinine and blood urea nitrogen
levels. Furthermore, coadministration of gentamicin and
erythropoietin effectively reduced the kidney tissue damage
induced by gentamicin, compared to the control group. Our
investigation disclosed the kidney protective effect of
erythropoietin, when the drug was given in combination with
gentamicin. However, the protective properties of erythro-
poietin were evident even when the drug was applied after
induction of tubular damage by gentamicin, and it was still
effective after tissue injury.2 This indicates that erythropoi-
etin may have a curative effect, in addition to its preventive
properties.2 Thus, erythropoietin is a promising kidney pro-
tective agent that can prevent, ameliorate, or attenuate
tubular damage induced by gentamicin or other nephrotoxic
agents such as cyclosporine.3,4 Various studies have also
shown the beneficial effect of erythropoietin on renal allo-
graft survival. It seems reasonable that we start erythropoi-
etin prior to erythropoiesis, as Yeh et al1 described in theirDOI of original article: http://dx.doi.org/10.1016/
j.jfma.2013.05.005.
0929-6646/$ - see front matter Copyright ª 2013, Elsevier Taiwan LLC
http://dx.doi.org/10.1016/j.jfma.2013.05.006article; however, the curative effect of this drug should also
be considered. In this regard, to better understand the
renoprotective properties of erythropoietin, more experi-
mental or clinical studies are suggested.
Conflicts of interest
The authors have no conflicts of interest relevant to this
article.
References
1. Yeh PY, Liao FL, Lin SL. Reply to comment on: Is the renopro-
tective effect of erythropoietin in chronic kidney disease a
myth? J Formos Med Assoc 2013;113:63e4. http://dx.doi.org/
10.1016/j.jfma.2013.03.005.
2. Rafieian-Kopaei M, Nasri H, Nematbakhsh M, Baradaran A,
Gheissari A, Rouhi H, et al. Erythropoietin ameliorates
gentamicin-induced renal toxicity: a biochemical and histopath-
ological study. J Nephropathol 2012;1:109e16.
3. Kadkhodaee M. Erythropoietin; bright future and new hopes for
an old drug. J Nephropathol 2012;1:81e2.
4. Gobe GC, Morais C, Vesey DA, Johnson DW. Use of high-dose
erythropoietin for repair after injury: a comparison of out-
comes in heart and kidney. J Nephropathol 2013;2:154e65.
Mahmoud Rafieian-Kopaei
Medical Plants Research Center, Shahrekord University of
Medical Sciences, Shahrekord, Iran
Hamid Nasri*
Department of Nephrology, Division of Nephropathology,
Isfahan University of Medical Sciences, Isfahan, Iran*Corresponding author. Department of Nephrology,
Division of Nephropathology, Isfahan University of Medical
Sciences, Isfahan, Iran.
E-mail address: hamidnasri@med.mui.ac.ir
25 April 2013& Formosan Medical Association. All rights reserved.


Comment on: Is the renoprotective effect of erythropoietin in chronic kidney disease a myth?

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