Iranian Journal of Kidney Diseases
Year:2018 | Volume:12 | Issue:4|Papers Count:10

Introduction: End-stage renal disease (ESRD) results in unpleasant consequences for patients, their families, and also society. Annually, each country expends a huge amount for ESRD treatment. In addition, its prevalence is dramatically growing, though it can be prevented. Many countries do not have accurate epidemiologic data about this disease. We conducted this study to measure a pooled prevalence of ESRD in the Middle East.Materials and Methods: Included articles were prospective and retrospective cross-sectional and editorial studies from January 1990 till January 2015 from the Middle East area that reported the prevalence of ESRD and renal replacement therapy. To measure pooled prevalence of ESRD we used a random effect model. For evaluating publication bias and heterogeneity, we used the Egger test andI squared test, respectively.Results: After excluding duplicates and irrelevant studies, 18 articles remained in our study. The prevalence reported in these studies varied from 55 pmp to 818 pmp. The pooled prevalence of ESRD was 360 pmp (95% confidence interval, 290 pmp to 430 pmp; I2=100%; P<.001).Conclusions: Most of the countries in the Middle East are categorized as developing countries. We believe that the prevalence in this region is much higher than what we measured. They lack a data registry system for most of diseases like ESRD, while it is needed for better prevention and treatment of these diseases.

Chronic kidney disease is defined as a glomerular filtration rate lower than 60 mL/min/1.73 m2, which is regarded as a public health priority and part of the growing burden of noncommunicable diseases. Reduced kidney function is concomitant with high levels of inflammatory factors, abnormal lipid profile, and anemia, as well as bone abnormalities, calcium deposition outside the bones, endothelial dysfunction, and cardiomyopathy. Furthermore, metabolic acidosis is a common complication in chronic kidney disease that is associated with secondary hyperparathyroidism and faster kidney disease progression. Effective preventive approaches may slow progression of chronic kidney disease and reduce the risk of subsequent morbidity and mortality. It seems that correction of metabolic acidosis slows down the decline in glomerular filtration rate and is one of the noble approaches. A diet rich in fruits and vegetables instead of bicarbonate therapy is feasible and economical and appears to have a positive effect on kidney hemodynamic function.

Introduction: Pulmonary arterial hypertension (PAH) is a destructive disease that is characterized by vasoconstriction, alterations and abnormal angiogenesis in pulmonary vessels, and right ventricular dysfunction. There is no certain treatment known for this condition.Patients with PAH have a lower level of apelin in their blood and less apelin is secreted in their endothelial cells, but this condition is not investigated in hemodialysis patients. This study aimed to compare apelin level in hemodialysis patients with and without PAH.Materials and Methods: Forty hemodialysis patients with PAH were compared with 40 patients without the condition. Apelin serum level was measured using an enzyme-linked immunosorbent assay technique. Dialysis adequacy was measured and its relationship with apelin level and the pulmonary arterial pressure was investigated.Results: The mean level of apelin in the group suffering from PAH was 54.87±23.50 ng/L, while it was 76.85±34.66 ng/L in those without PAH (P=.001). It was also found that hemodialysis adequacy had no effect on apelin level or pulmonary arterial pressure.Conclusion: The findings of our study suggest that in hemodialysis patients with PAH, apelin peptide serum levels are significantly lower than patients with normal arterial pressure and this condition is not affected by hemodialysis.

Introduction: Chronic kidney disease-mineral and bone disorder is a common complication in hemodialysis patients. The present study was designed to investigate the effects of flaxseed oil, a rich source of plant omega-3 fatty acid alpha-linolenic acid, on serum markers of bone formation and resorption in hemodialysis patients.Materials and Methods: In this randomized controlled trial, 34 hemodialysis patients were randomly assigned to either the flaxseed oil or the control group. The patients in the flaxseed oil group received 6 g/d of flaxseed oil for 8 weeks, whereas the control group received 6 g/d of medium chain triglycerides oil. At baseline and the end of the 8th week, 7 mL of blood was obtained from each patient after a 12- to 14-hour fast and serum concentrations of osteocalcin, osteoprotegerin, N-telopeptide, and receptor activator of nuclear factor kappa B ligand were measured.Results: Serum N-telopeptide concentration decreased significantly up to 17% in the flaxseed oil group at the end of week 8, as compared to baseline (P<.01), and the reduction was significant in comparison with the control group. There were no significant differences between the two groups in the mean changes of serum osteocalcin, osteoprotegerin, or receptor activator of nuclear factor kappa B ligand.Conclusions: This study indicates that daily consumption of 6 g/d of flaxseed oil may reduce bone resorption in hemodialysis patients.

Introduction: The vitamin D-receptor axis is involved in multiple physiological functions and altered states such as hypertension, mineral metabolism disorders, and inflammation. These disturbances are major risk factors for progression to end-stage kidney disease and cardiovascular disease. In addition, changes in internal systemic environment could be influencing the impact of survival in patients with kidney disease. This study aimed to evaluate the impact of vitamin D receptor (VDR) polymorphisms on hemodialysis patients’ survival.Material and Methods: A total of 122 hemodialysis patients and 120 healthy controls were compared for VDR gene polymorphism. Markers for full coverage in the VDR gene were selected and genotyped. The hemodialysis patients were followed until death event, which was considered the primary endpoint for the survival analysis.Results: Two tag SNPs (rs10875695 and rs11168293) showed significant differences between the hemodialysis and healthy patients. In survival analysis, the CC genotype for rs2248098, compared to the TT genotype, was associated with a worse mortality rate. After adjustments for age, sex, diabetes mellitus, and cardiovascular disease, the genotype CC (rs2248098) was associated with a higher risk of mortality in a multivariable analysis.Conclusions: Polymorphisms specific to patients with kidney disease could be influencing different conditions associated with mortality. Thus, these genetic markers, rs2248098 for example, would act in a specific time in the history of kidney disease and would bring different results of patient survival outcomes.

Introduction: Many studies have reported increased intimal thickness around the catheter tip after catheterization. Caveolin-1 is a protein in the endothelial cell that acts as a shear sensor causing vascular remodeling. This study aimed to elucidate the suitability of different catheter locations and determine the role of caveolin-1 in canine models.Materials and Methods: Tunneled silicone 14.5-F catheters were inserted into the left jugular vein and right femoral vein in 8 dogs. The dogs were separated into 2 groups by catheter location and were followed up for 28 days. All dogs underwent extracorporeal circulation 3 times a week. After animal sacrifice, histological and immunohistochemical assays were performed to measure specific cell populations.Results: There were higher catheter dysfunction rates and lower blood flow rates in the right femoral vein group compared to the left jugular vein group. There was intimal hyperplasia around the catheter tip in both groups with no significant difference between the two groups. There were caveolin-1 expression in the intimal layer of venous wall around the catheter tip location sites in both groups.Conclusions: These findings indicate that different catheter tip locations may influence catheter function and specific targeting of caveonlin-1 could be a strategy of possible future novel therapies for catheter-related vein stenosis.

Nephronophthisis is an autosomal recessive cystic kidney disease characterized by tubular interstitial infiltration, periglomerular fibrosis, and cysts, and is the most frequent genetic cause of endstage renal disease in children. Nephronophthisis is pleiotropic as almost all the causative genes are involved in primary cilium and centrosome function which are found in almost all human cells. Genetic heterogeneity in nephronophthisis makes the molecular and genetic diagnosis somewhat difficult. Homozygous deletions in the nephronophthisis 1 (NPHP1) gene are the major contributor of nephronophthisis cases, while other genes accounts for less than 3% each. Nephronophthisis-related ciliopathy is a term used for extrarenal symptoms in addition to nephronophthisis. Herein, we are reporting the molecular study of 7 children from independent families fulfilling the criteria of nephronophthisis. A deletion analysis of theNPHP1 gene was performed in each case, andNPHP5 mutation screening was performed in the absence of such deletion in patients with Senior Loken syndrome.

Awareness of the uncommon associated clinical manifestations of immunoglobulin G4 (IgG4) -related kidney disease is essential for the early diagnosis and effective treatment of patients. To the best of our knowledge, there have been few reports of patients with IgG4-related kidney disease associated with autoimmune hemolytic anemia. We here report a rare case of IgG4-related kidney disease associated with autoimmune hemolytic anemia. A 70-year-old man with kidney dysfunction and severe anemia had been diagnosed with chronic kidney disease and treated without any improvement. On admission, he had a high serum creatinine level, low hemoglobin level, positive direct Coombs test, and mild proteinuria. Serum IgG and IgG4 were elevated. Kidney biopsy showed marked infiltration of IgG4-positive plasma cells and storiform fibrosis in the interstitial compartment, which confirmed the diagnosis of IgG4-related kidney disease. Corticosteroid therapy was initiated, and subsequently, the kidney dysfunction and anemia dramatically improved.

Urinary tract anomalies are common and comprise about 20% to 30% of total congenital anomalies. This spectrum consists of many different anomalies of the urinary tract that may be syndromic or nonsyndromic with different etiologies. In this case report, a patient with single kidney and urinary tract signs is introduced that was diagnosed accidentally. The finding of different anomalies in different organ systems should lead us to examination of the intactness of the urinary tract. In these disorders, if there is no need for immediate intervention, long-term follow-up can be helpful to postpone chronic kidney disease progression.

Dear Editor: Thrombotic thrombocytopenic purpura (TTP) is a microangiopathic hemolytic disorder that is induced by a marked reduction in the level of von Willebrand factor-cleaving protease, a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS-13).