فهرست مطالب

Journal of nephropathology
Volume:3 Issue: 3, Jul 2014

  • تاریخ انتشار: 1393/06/02
  • تعداد عناوین: 6
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  • Muhammed Mubarak *, Hamid Nasri Pages 87-90
    Implication for health policy/practice/research/medical education: Lupus nephritis (LN) is the most dreadful complication of systemic lupus erythematosus (SLE) and is responsible for the major share of morbidity and mortality of this disease. Its diagnosis, classification and management have posed significant challenges to the nephrologists and pathologists over the past several decades. A series of WHO classifications of LN were followed by the development of the international society of nephrology/renal pathology society (ISN/RPS) classification of LN in 2003. The classification has largely succeeded in achieving its goals, but a few limitations have also been exposed. It is time to revisit the classification in the light of experience of validation studies and new emerging data on this disease.
    Keywords: Lupus nephritis, Extracapillary proliferation, Antiphospholipid antibodies
  • Aravind Chandra, Michael Biersmith, Ramin Tolouian * Pages 91-97
    Context: Obesity, both directly and indirectly, increases the risk for a variety of disease conditions including diabetes, hypertension, liver disease, and certain cancers, which in turn, decreases the overall lifespan in both men and women. Though the cardiovascular risks of obesity are widely acknowledged, less often identified is the relationship between obesity and renal function. Evidence Acquisitions: Directory of Open Access Journals (DOAJ), Google Scholar, PubMed, EBSCO and Web of Science has been searched.
    Results
    The concept of the «Metabolic Syndrome» helps us to understand this close link between obesity, diabetes, hypertension, and renal dysfunction. An elevated body mass index has shown to be one of the major determinants of glomerular hyperfiltration that lead to the development of chronic kidney disease. Interestingly, weight loss can lead to attenuation of hyperfiltration in severely obese patients suggesting a possible therapeutic option to combat obesity-related hyperfiltration.
    Conclusions
    Various treatment strategies had been suggested to decrease impact of obesity on kidneys. These are blood pressure controling, inhibition of the renin-angiotensin-aldosterone axis, improving glycemic control, improving dyslipidemia, improving proteinuria and lifestyle modifications. Regardless of the numerous pharmacotherapies, the focus should be on the root cause: obesity.
    Keywords: Fat, Metabolic syndrome, Renal disease
  • Sarmad Said, German T. Hernandez * Pages 99-104
    Context: It is well known that patients with chronic kidney disease (CKD) have a strong risk of cardiovascular disease (CVD). However, the excess risk of cardiovascular disease in patients with CKD is only partially explained by the presence of traditional risk factors, such as hypertension and diabetes mellitus. Evidence.Acquisitions: Directory of Open Access Journals (DOAJ), Google Scholar, PubMed, EBSCO and Web of Science has been searched.
    Results
    Chronic kidney disease even in its early stages can cause hypertension and potentiate the risk for cardiovascular disease. However, the practice of intensive blood pressure lowering was criticized in recent systematic reviews. Available evidence is inconclusive but does not prove that a blood pressure target of less than 130/80 mmHg as recommended in the guidelines improves clinical outcomes more than a target of less than 140/90 mmHg in adults with CKD.
    Conclusions
    The association between CKD and CVD has been extensively documented in the literature. Both CKD and CVD share common traditional risk factors, such as smoking, obesity, hypertension, diabetes mellitus, and dyslipidemia. However, cardiovascular disease remains often underdiagnosed und undertreated in patients with CKD. It is imperative that as clinicians, we recognize that patients with CKD are a group at high risk for developing CVD and cardiovascular events. Additional studies devoted to further understand the risk factors for CVD in patients with CKD are necessary to develop and institute preventative and treatment strategies to reduce the high morbidity and mortality in patients with CKD.
    Keywords: Cardiovascular disease, Chronic kidney disease, Hypertension, Diabetes mellitus
  • Mohammad Kazem Fallahzadeh, Rajini Kanth Yatavelli, Ajay Kumar, Neeraj Singh * Pages 105-108
    Background
    Acute renal artery thrombosis is a devastating complication of renal transplantation that can result in graft loss if not detected early. Surgical and technical errors are the major cause of renal artery thrombosis. In this article, for the first time, we are reporting a case of acute renal artery thrombosis that developed early post-transplantation due to distal renal artery stenosis.
    Case Presentation
    A 71-year-old woman presented with nausea, vomiting and decreased urine output 7 days after a deceased donor kidney transplant. Doppler ultrasound showed absent renal and venous flow in the transplanted kidney. Transplant renal artery angiogram showed renal artery thrombosis. Catheterization and thrombectomy were done in the occluded renal artery. After thrombectomy, renal angiogram showed distal renal artery stenosis which was dilated by stenting. Post-stenting angiogram showed good blood flow in the entire renal arterial system. However, the patient’s kidney function did not improve within next 24 hours and the patient eventually lost the kidney. Kidney biopsy showed widespread kidney infarction with no evidence of rejection.
    Conclusions
    Our case shows that renal artery thrombosis can develop due to distal renal artery stenosis and if not detected early could result in graft loss.
    Keywords: Renal artery thrombosis, Doppler ultrasound, Graft loss, Thrombectomy
  • Behzad Einollahi, Jafar Aslani, Mehrdad Taghipour *, Mohsen Motalebi, Hamidreza Karimi-Sari Pages 109-113
    Background
    Sirolimus is immunosuppressive drug used to prevent rejection in kidney transplantation. Pulmonary problems are one of the serious complications which may be seen after administration of this drug and it is believed that it could be life threatening.
    Case Presentation
    Here in this paper we presented a 49-years-old man with bronchiolitis obliterans organizing pneumonia (BOOP) induced by chronic use of Sirolimus. The disease was diagnosed and successfully treated.
    Conclusions
    Sirolimus uses after kidney transplantation may lead to lung complications, especially BOOP, and the prompt diagnosis would allow earlier treatment.
    Keywords: Pneumonia, Sirolimus, Transplant
  • Hamid Nasri, Ali Ahmadi, Azar Baradaran, Ali Momeni, Parto Nasri, Saeed Mardani, Mahmood Rafieian-Kopaei, Muhammed Mubarak * Pages 115-120
    Background
    Renal biopsies play an important role in the diagnosis, management and prognosis of patients with lupus nephritis (LN).
    Objectives
    To determine the correlation between the pathological features of LN and the demographic, clinical and laboratory parameters. Patients and
    Methods
    This retrospective study was conducted from 2008 to 2014 on all consecutive cases of biopsy-proven LN at a nephropathology laboratory in Iran. The demographic, clinical and laboratory data were obtained from patients’ files and the biopsy findings from the original biopsy request forms.
    Results
    Of the 84 patients enrolled, 69 (82.2%) were females and 15 (17.8%) males. The mean age was 32.7±12 years. The mean serum creatinine was 1.5±0.94 mg/dl and the mean 24-h proteinuria, 1.6±1.9 grams. The majority of cases belonged to classes III and IV. The extracapillary proliferation was found in 42.86% of biopsies and endocapillary proliferation in 66.67% of biopsies. Patients of class IV-LN had a higher mean serum value of creatinine in comparison to class III-LN (2.19±1.09 versus 1.2±0.56 mg/dl; p= 0.0001). There was no significant difference of 24-h proteinuria between the two classes (p= 0.882). A significant association of serum creatinine with 24-h proteinuria (p= 0.041) was seen. Serum creatinine had significant positive correlation with activity percent (p< 0.001), and chronicity percent (p= 0.006), and also with proportion of glomeruli with crescents (p < 0.001). While there was a significant relationship of proteinuria with chronicity percent (p= 0.001), this association for activity percent was not significant (p= 0.094). Furthermore, the association of proteinuria with totally sclerotic glomeruli and proportion of crescents was not statistically significant (p= 0.186 and p= 0.0145 respectively).
    Conclusions
    In conclusion, the results from our study on biopsy-proven cases of LN largely concur with the previously reported studies from Iran and other parts of the world.
    Keywords: Crescents, Lupus nephritis, Proteinuria, Renal biopsy