سال:1399 | دوره: | شماره: |تعداد مقالات:13

The global burden of chronic kidney disease (CKD) is rapidly increasing with a projection of becoming the 5th most common cause of years of life lost globally by 2040. Aggravatingly, CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplantation consume up to 3% of the annual healthcare budget in high-income countries. Crucially, however, the onset and progression of CKD is often preventable. In 2020, the World Kidney Day campaign highlights the importance of preventive interventions – be it primary, secondary, or tertiary. This complementing article focuses on outlining and analyzing measures that can be implemented in every country to promote and advance CKD prevention. Primary prevention of kidney disease should focus on the modification of risk factors and addressing structural abnormalities of the kidney and urinary tracts, as well as exposure to environmental risk factors and nephrotoxins. In persons with pre-existing kidney disease, secondary prevention; including blood pressure optimization and glycemic control, should be the main goal of education and clinical interventions. In patients with advanced CKD, management of co-morbidities such as uremia and cardiovascular disease is a highly recommended preventative intervention to avoid or delay dialysis or kidney transplantation. Political efforts are needed to proliferate the preventive approach. While national policies and strategies for non-communicable diseases might be present in a country, specific policies directed toward education and awareness about CKD screening, management and treatment are often lacking. Hence, there is an urgent need to increase the awareness of the importance of preventive measures throughout populations, professionals and policy makers.

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease and oxidative stress (OS) has been recognized as a key factor in the pathogenesis and progression. Hyperglycemia, reactive oxygen species, advanced glycation end products, arterial pressure, insulin resistance, decrease in nitric oxide, inflammatory markers, and cytokines, among others; are involved in the presence of OS on DN. This revision focus on diverse studies in experimental and human models with diabetes and DN that has been demonstrated beneficial effects of different dietary antioxidant as resveratrol, curcumin, selenium, soy, catechins, α-lipoic acid, coenzyme Q10, omega-3 fatty acids, zinc, vitamins E and C, on OS and the capacity for antioxidant response. Therefore, this interventions could have a positive clinical impact on DN.

End-stage renal disease (ESRD) is a foremost health issue with major consequences in various parts of the world. In Iran, the prevalence/incidence of ESRD has increased during the past decades. The economic burden of ESRD treatment on patients, their families, and the whole healthcare system is huge as well. Hence ESRD is considered emerging public health problem in developing countries, including Iran, requiring short-and longterm changes in healthcare policies. Developing a national registry system for dialysis patients in Iran now enables us to summarize certain clinical characteristics of these patients and compares the present situation with the late 1990s when dialysis services just began to expand in the country. In this paper, the authors provide information regarding the process of establishing dialysis registry in Iran along with the report of the output of such a registry. Focusing on such an important measure in the whole country of around along with the data that it has produced is a gateway to further progress.

Treatment for end stage renal disease patients is based on dialysis; however, the presence of access recirculation (AR) decreases dialysis efficiency and adequacy. This study was conducted to determine the recirculation rate in dialysis patients undergoing hemodialysis through using a permanent catheter. 60 patients including 23 males and 37 females were enrolled. Mean age of the participants was 57. 66 (± 14. 08) years. Mean AR in the subjects was 9. 36%, and 16 (27%) of patients had mean AR above 10%. Moreover, there was a significant correlation between AR and catheter longevity (P <. 001). It is suggested to limit the use of permanent catheters to specific cases and not to use them in place of arteriovenous fistulas.

Introduction. Previous studies have shown that TGF-β 1/Smad3 signaling promotes renal fibrosis by inhibiting miR-29. To date, only few studies have reportedon circulating microRNAs in IgA nephropathy (IgAN). However, the plasma expression of miR-29a and its role in patients with IgAN remains unclear. In this study, we attempted to elucidate whether plasma miR-29a expression can be used as a biomarker for monitoring disease states. Methods. For this study, 15 healthy subjects, 36 patients with untreated renal biopsy-proven IgAN, and 79 patients with IgAN, who were under treatment for a period of 1 year on an average, all of whom had similar age and gender distributions, were included. The plasma expression of miR-29a in each group was explored by real-time PCR, and the relationship between miR-29a expression and clinical, pathological, and prognostic indicators of IgAN was further evaluated. Results. Relative plasma expression of miR-29a in patients with IgAN was significantly lower than that in healthy controls (P <. 001), and these changes in plasma miR-29a could be suppressed by treatment (P <. 05). Plasma miR-29a was positively correlated with eGFR and negatively correlated with proteinuria and serum creatinine, irrespective of whether or not the patients with IgAN accepted treatment (P <. 05). Plasma miR-29a level was negatively correlated with primary pathological parameters such as crescent formation, Lee’ s and Oxford classification (P <. 05). Kaplan– Meier analysis revealed that patients with high plasma expression of miR-29a had better renal function and better response to treatment compared to those with low expression (P <. 05). Conclusion. Plasma miR-29a could be considered as a biological marker that reflects renal damage and function, to predict the progression of IgAN.

Introduction. CKD is one of the most prevalent entities associated with high morbidity and mortality. Most of the patients with renal diseases, particularly patients undergoing dialysis, suffer from cardiovascular disease and it is necessary to employ appropriate strategies to prevent and manage this complication. The aim of this study was to evaluate the anti-inflammatory effects of omega-3 in patients undergoing CAPD. Methods. Nineteen CAPD patients with certain inclusion and exclusion criteria enrolled in this study. Omega-3 capsules with a dose of 1 g/d up to three months, were administrated. Some inflammatory markers such as ESR, CRP, HS-CRP, IL-6, MDA, and homocysteine were measured in three phases. In addition, lipid profile including triglyceride, cholesterol, LDL, and HDL were measured. Results. Results of this study showed that CRP, HS-CRP, and homocysteine levels increased insignificantly (P >. 05) whereas, MDA level was increased significantly (P <. 05). ESR and IL-6 levels both decreased but did not show any statistically significance (P >. 05). Results of lipid profile also suggested that none of the lipid levels changed significantly (P >. 05). Conclusion. It is necessary to design large trials in order to understand clear effects of omega-3 on inflammatory markers in PD patients. In addition, the results of this current pilot study should be interpreted with caution.

Introduction. It has not yet been clear whether intradialytic hypertension (IDHN) translates into the presence of high BP between dialysis sessions or not. In this study, we aimed to perform interdialytic ambulatory blood pressure monitoring (ABPM) in patients with IDHN to find whether high BP persists at home. Methods. In this case-control study, ABPM was performed during a 44-hours interdialytic period in patients on maintenance hemodialysis (HD) with pre-dialysis systolic BP (SBP) above 130 mmHg. Bland-Altman graphs were used to investigate the magnitude of the difference between the results of ABPM records and intradialytic BP measurements in patients with and without IDHN. Results. A total of 56 patients were enrolled in our study (29 in the IDHN group and 27 in the control group). The average of the pre-dialysis SBP in 6 consecutive HD treatments was 146. 6 ± 11. 36 vs. 146. 8 ± 12. 1 mmHg in IDHN and control group, respectively (P >. 05). Mean post-dialysis SBP was 154. 45 ± 12. 6 mmHg in the IDHN group and 136. 76 ± 11. 50 in the control group (P <. 001). Mean ± SD of 44-hour SBP was 157. 31 ± 20. 27 mmHg in the IDHN group, which was significantly higher than that in the control group (146. 5 ± 16. 67 mmHg, P <. 05). No significant differences were seen in the average of interdialytic weights gain between the two groups. Compared to the pre-dialysis SBP, using Bland-Altman graphs, the post-dialysis SBP (bias of 3. 5 mmHg) had closer readings to the daytime SBP in the IDHN group. Conclusion. Patients with IDHN had higher interdialytic BPs. Among BPs taken during HD in patients with IDHN, post-dialysis SBP had the lowest difference with the daytime SBP taken by ABPM.

Introduction. The purpose of the present study was to identify the prevalence of sleep disturbances in ESRD, and to compare the sleep quality before and after kidney transplantation. Methods. A semi-experimental study was performed on 40 participants with ESRD from September 2017 to September 2018 in Mashhad, Iran. Participants were in the waiting list of kidney transplantation, aged 18-years-old or more, had no history of any major psychological problems. They were excluded from the study if new medical condition or psychiatric disorder was initiated throughout the study. Patients’ medical information including the duration of dialysis and laboratory data was extracted from medical records. Their sleep quality was assessed with the Pittsburgh sleep quality index (PSQI) within1-month prior the kidney transplantation and at the 3rd and 6th months after it. Collected data was analyzed using SPSS-16. P <. 05 considered as significant. Results. The frequency of poor sleepers was 37. 5%, 37. 5%, and 20. 0%; before the kidney transplantation, 3 months and 6 months after the surgery; respectively. The average sleep quality score decreased significantly 6-month post-operation compared to pre-transplant phase (P < 0. 05). We found a significant relationship between the gender and quality of sleep before transplant surgery, whereas no correlation was found between sleep quality and the age, type or duration of dialysis, serum phosphorus or hemoglobin level, and the cause of kidney failure (P <. 05, >. 05, >. 05, >. 05, >. 05, >. 05, and >. 05; respectively). Conclusion. Kidney transplantation has a positive effect on patients’ sleep quality after 6 months.

Introduction. There are some randomized trials which have already evaluated different calcineurin inhibitors (CNIs), especially comparing Tacrolimus and Cyclosporine, as immunosuppressant agents in children. However, their findings have been occasionally conflicting and thus debatable. Therefore, the evidence on safety and efficacy of immunosuppressive therapy after kidney transplantation in children has been inconclusive and argued to date. This study was aimed to compare the benefits and disadvantages of tacrolimus versus cyclosporine as the primary immunosuppression after renal transplantation in children. Methods. A systematic review and meta-analysis was done. An electronic literature review was conducted to identify appropriate studies. The outcomes were presented as relative risk, with 95% confidence intervals. Results. Five qualified randomized controlled trials were included in this systematic review. Tacrolimus was insignificantly superior to cyclosporine considering the total effect size of graft loss (RR = 0. 67, 95% CI: 0. 40-1. 11; P >. 05) and acute rejection (RR = 0. 79, 95% CI: 0. 59 – 1. 05; P >. 05). On the contrary, cyclosporine seemed to be insignificantly superior to tacrolimus regarding mortality rate (RR = 1. 06, 95% CI: 0. 59-1. 90; P >. 05). Conclusion. Admitting the study limitations mainly because of the nature and case study size of the included trials, it can be concluded from our systematic review results that Tacrolimus seems insignificantly superior to Cyclosporine respecting graft loss and acute rejection. However, Cyclosporine was shown to be insignificantly superior regarding mortality rate. However additional studies with a larger sample size are highly recommended.

Introduction. Renal dysfunction is among the common and considerable complications after liver transplantation and is principally attributable to immunosuppressive medications. The purpose of this study was to define the prevalence of hypertension and renal dysfunction among pediatric liver transplant recipients. Methods. 46 pediatric liver transplant recipients were assessed for hypertension utilizing ambulatory blood pressure monitoring (ABPM), and glomerular, and tubular renal function at the transplant clinic of Shiraz University of Medical Sciences. Results were analyzed using SPSS 19 and P value <. 05 was considered statistically significant. Results. The mean age of the patients was 12. 2 ± 3. 3 years and 24 of them were female. Considering ABPM measurements 20 patients (43. 5%) were hypertensive, 37% were systolic and 36. 6% were diastolic non-dippers respectively. eGFR was calculated based on different formulations and Cystatin C– based equation estimated lower GFR than Cr-based equation. Micro-albuminuria was noticed in 26. 1%. Additional parameters of tubular dysfunction included hyperuricosuria (4. 3%), hypercalciuria (6. 5%), abnormal fractional excretion of Mg (FeMg) (43. 5%), abnormal tubular reabsorption of phosphate (TRP) (4. 3%), and abnormal fractional excretion of uric acid (FEUA) in 13% of the patients. We noticed a statistically significant negative correlation between hypercalciuria, microalbuminuria, FeMg (P <. 05) and GFR. Conclusion. Renal function impairment and hypertension are frequent complications amongst pediatric liver transplant recipients. Using Cyctatin C instead of Cr based formula for GFR estimation, and blood pressure monitoring by ABPM and regular screening of renal function are essential measures for recognition and treatment of renal dysfunction in these patients.

Bardet-biedl syndrome (BBS) is a rare heterogenous autosomal recessive disease due to defects in primary cilia which until now, up to 21 types have been detected. A few reports of BBS in Iran have been published but this is the first type 9 genotyped and clinically discussed case. This type can cause severe and delayed onset renal failure.

Introduction. Metformin-associated lactic acidosis is rare despite its widespread use. It is often associated with the use of metformin in the presence of chronic kidney disease, but it may also occur in people with normal renal function in the case of acute overdose. Case Report. 20 years old (patient 1) and 37 years old (patient 2) women without any chronic disease took 40 gram (727 mg/ kg) and 60 gram (1200 mg/kg) metformin, respectively; for the suicidal attempt. Deep lactic acidosis was detected in patients. In patient 1, hemodialysis was performed for 4 hours. After the interruption, deep acidosis evolved again and another dialysis session was performed. In patient 2, hemodialysis was performed for 16 hours without any interruption and she did not need any other dialysis session. Conclusion. Metformin has a large distribution volume. It is not correct to make a final decision as to how long the dialysis will continue when dialysis begins. Dialysis should be continued without interruption until clinical and laboratory targets are achieved.

Introduction. The main reason for this study is regarding the importance of correct estimation, which can consequently decreases the risk of under or over estimation. Methods. This was an observational analytic cross-sectional study. An online data collection tool “ Google Form” was used to gather personal information and self-assessment score. Results. From the 121 participants, the majority of them (76) were women. Most of the participants (33. 9%) were seventh-year medical students. The results of this study showed that 100% of the participants believed that they possessed the skillset to measure BP correctly with an average self-assessment score of 8. 20 ± 1. 05. However, the mean total score for the participants was 3. 69 ± 1. 59, with only two of the participants scoring as high as 7. Conclusion. The majority of participants attained low average score of correct blood pressure measurements. However, they noted high self-assessment scores before conducting the study. This disparity between reported results may show and emphasizes the importance of considering these 11 tips in the BP training courses.