فهرست مطالب

nephropathology - Volume:5 Issue: 1, Jan 2016

Journal of nephropathology
Volume:5 Issue: 1, Jan 2016

  • تاریخ انتشار: 1394/11/25
  • تعداد عناوین: 10
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  • Thomas Jouve, Lionel Rostaing, Paolo Malvezzi Pages 1-7
    Context: BK virus (BKV) viremia and BKV-associated nephropathy (BKVAN) have become a serious nuisance to kidney transplant (KT) patients since the mid-nineties, when the incidence of this disease has increased significantly. Evidence Acquisition: Directory of open access journals (DOAJ), EMBASE, Google Scholar, PubMed, EBSCO, and Web of Science have been searched.
    Results
    Many hypothesis have been made as to why this phenomenon has developed; it is of general opinion that a more potent immunosuppression is at the core of the problem. The use of the association of tacrolimus (TAC) with mycophenolic acid (MPA) has gained momentum in the same years as the increase in BKV viremia incidence making it seem to be the most likely culprit. m-TOR inhibitors (m-TORIs) have been shown to have antiviral properties in vitro and this fact has encouraged different transplant teams to use these agents when confronted with BKV infection (viremia or nephropathy). However, the results are mitigated. There had been conflicting results for example when converting from TAC-to sirolimus-based immunosuppression in the setting of established BKVAN.
    Conclusions
    In order to prevent BKV infection we have to minimize to some extent immunosuppression, but it is not always possible, e.g. in high immunological risk patients. Conversely, we could use m-TORIs associated with low-dose calcineurin inhibitors (CNIs). This could be actually the key to a safe immunosuppression regimen both from the immunological stand point and from the viral one.
    Keywords: Kidney transplantation, BK virus infection, BKV, associated nephropathy, Sirolimus, Everolimus, Immunosuppression
  • Haydarali Esmaili, Elmira Mostafidi, Bahareh Mehramuz, Mohammadreza Ardalan, Mohammadali Mohajel, Shoja Pages 8-14
    Context: Hemophagocytic syndrome (HPS) is mainly characterized by massive infiltration of bone marrow by activated macrophages and often presents with pancytopenia. Thrombotic microangiopathy (TMA) is also present with thrombocytopenia and renal involvement. Both conditions could coexist with each other and complicate the condition. Evidence Acquisition: Directory of Open Access Journals (DOAJ), EMBASE, Google Scholar, PubMed, EBSCO, and Web of Science with keywords relevant to; Hemophagocytic syndrome, macrophage activation syndrome, interferon-gamma and thrombotic microangiopathy, have been searched.
    Results
    Viral infection, rheumatologic disease and malignancies are the main underlying causes for secondary HPS. calcineurin inhibitors and viral infections are also the main underlying causes of TMA in transplant recipients. In this review, we discussed a 39-year-old male who presented with pancytopenia and renal allograft dysfunction. With the diagnosis of HPS induced TMA his renal condition and pancytopenia improved after receiving intravenous immunoglobulin (IVIG) and plasmapheresis therapy.
    Conclusions
    HPS is an increasingly recognized disorder in the realm of different medical specialties. Renal involvement complicates the clinical picture of the disease, and this condition even is more complex in renal transplant recipients. We should consider the possibility of HPS in any renal transplant recipient with pancytopenia and allograft dysfunction. The combination of HPS with TMA future increases the complexity of the situation.
    Keywords: Hemophagocytic syndrome, Macrophage activation syndrome, Interferon, gamma, Thrombotic microangiopathy
  • Hamid Nasri, Mahmoud Rafieian, Kopaei Pages 15-18
    Context: World kidney day is a yearly global alertness and education ceremony, held on the second Thursday in March. Evidence Acquisition: Directory of open access journals (DOAJ), EMBASE, Google Scholar, PubMed, EBSCO, and Web of Science have been searched.
    Results
    Once again we reached to March 14, the world kidney day of 2016. This is the 10th anniversary of world kidney day, a program of the International Society of Nephrology (ISN) and the International Federation of Kidney Foundations (IFKF). World kidney day first began in 2006 and the worldwide campaign highlights a specific theme each year. The theme for 2015 was to invite everybody to drink a glass of water and give one, too, to celebrate their kidneys. This is a symbolic action to memorize that kidneys are vital organs and that they might be cared.
    Conclusions
    It is a manner to make individuals more conscious about their lifestyle choices. In this year, world kidney day will be celebrated on Thursday March 10, 2016. The theme for 2016 will highlight on renal disease and children.
    Keywords: Chronic renal failure, World kidney day, Acute kidney injury, Renoprotection
  • Hamza Naciri Bennani, Zhyiar Abdulrahman, Asma Allal, Federico Sallusto, Antoine Delarche, Xavier Game, Laure Esposito, Nicolas Doumerc, BÉnÉdicte Debiol, Nassim Kamar, Lionel Rostaing Pages 19-27
    Background
    Living-kidney transplantation is increasing because of the scarcity of kidneys from deceased donors and the increasing numbers of patients on waiting lists for a kidney transplant. Living-kidney transplantation is now associated with increased long-term patient- and allograft-survival rates.
    Objectives
    The purpose of this retrospective study was to identify, in a cohort of 44 ABO-incompatible (ABOi) live-kidney transplant patients, the main complications that occurred within 6 months post-transplantation, and to compare these findings with those from 44 matched ABO-compatible (ABOc) live-kidney transplant patients who were also from our center.Patients and
    Methods
    This single-center retrospective study assessed post-transplantation complications in 44 ABO-i versus 44 matched ABO-c patients. All patients were comparable at baseline except that ABO-i patients had greater immunological risks.
    Results
    During the 6-month post-transplant period, more ABO-i patients presented with postoperative bleeds, thus requiring significantly more blood transfusions. Bleeds were associated with significantly lower values of fibrinogen, platelets, prothrombin time, and hemoglobin levels. Surgical complications, patient- and graft-survival rates, and kidney-function statuses were similar between both groups at 6 months post-transplantation.
    Conclusions
    We conclude that impairment of hemostatic factors at pre-transplant explained the increased risk of a post-transplant bleed in ABO-i patients.
    Keywords: Kidney transplantation, Bleeding, Surgical complications, BK virus, Blood transfusion, Fibrinogen
  • Mohammad Reza Jafari, Nakhjavani, Sima Abedi, Azar, Babak Nejati Pages 28-33
    Background
    Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by activation of T and polyclonal B lymphocytes. IL-18 was originally identified as a factor which enhances IFN-γ production and is a potent inducer of the inflammatory mediators by T cells, causing severe inflammatory disorders in SLE.
    Objectives
    This study aimed to evaluate the association of plasma interlukine-18 (IL-18) concentration and severity of lupus nephritis (LN) and disease activity in SLE patients.Patients and
    Methods
    In this cross-sectional study, 113 patients with SLE and 50 healthy individuals were examined. Serum level of IL-18 was measured. The severity and activity of the disease was determined by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score. The severity of kidney involvement was studied by renal biopsy, serum creatinine and 24 hours urine protein level.
    Results
    The mean level of serum IL-18 was significantly higher in the patients than controls (577.67 ± 649.95 versus 60.48 ± 19.53 pg/ml; P < 0.001). In SLE patients with active disease level of serum IL-18 was significantly higher than chronic disease (622.77 ± 716.54 versus 182 ± 184.37 pg/ml; P < 0.001). The serum level of IL-18 was significantly higher in stage IV (P < 0.001) and V (P < 0.001) of patients with LN, than other stages.
    Conclusions
    The current study showed that the serum IL-18 is significantly higher in the patients than controls and it significantly correlated with sever renal involvement and disease activity in SLE patients.
    Keywords: Systemic lupus erythematosus, Lupus nephritis, Interleukin, 18
  • Nicole Nesselhauf, Jaclyn Strutt, Bahar Bastani Pages 34-37
    Background
    BK virus reactivation is a significant complication following renal transplantation that can result in graft failure. Reduction of immunosuppression and substitution of leflunomide for mycophenolate mofetil (MMF) has been used to treat this entity.
    Objectives
    To evaluate the use of leflunomide in BK viremia (BKV) and biopsy proven BK nephropathy (BKN) in kidney and kidney-pancreas transplant recipients. Patients and
    Methods
    We retrospectively reviewed 28 kidney and kidney-pancreas transplant recipients who had received leflunomide for BKV from January 2006 to November 2012. Demographics, time to BKV diagnosis, biopsy findings, rejection episodes, and laboratory data were recorded.
    Results
    The average (mean ± SD) time to BKV from time of transplant was 316.1 ± 368.0 days (62-1708 days). At time of diagnosis, 64% of patients had their maintenance immunosuppression reduced. The indications for leflunomide administration were; BKV and biopsy proven acute rejection (BPAR) (50%), biopsy proven BKN (18%), or persistent BKV (25%). Therapeutic levels (50-100 mcg/mL) were achieved in only 54% of patients, and 60% of them had required a leflunomide dose of at least 60 mg/day. BK virus was cleared from the serum on average of 151 ± 145.2 days (17-476 days). At study commencement, 29% of patients had remained on leflunomide due to persistent BKV.
    Conclusions
    In our study, most patients required at least a 60 mg daily dose of leflunomide to achieve therapeutic levels and to clear the virus compared to the standard 40 mg daily dose. Delaying therapy may result in progressive BKV and BKN.
    Keywords: BK virus, Polyomavirus, BK viremia, BK nephropathy, Kidney transplant, Leflunomide
  • Narges, Sadat Zahed, Maryam Ghassami, Hajar Nikbakht Pages 38-43
    Background
    The most leading cause of death in end-stage renal disease (ESRD) patients are cardiovascular disease and inflammatory markers are related to coronary events. CO-Q10 (coenzyme Q10) is a protective supplement from free radical oxidative damage. In addition, hyperhomocysteinemia is an independent coronary artery disease (CAD) risk factor.
    Objectives
    Due to increasing oxidative stress in dialysis patients, and the effect of CO-Q10 in decrease oxidative stress, in this work, we assessed the effect of CO-Q10 on C-reactive protein (CRP) level as an inflammatory marker and homocysteine in dialysis patients.Patients and
    Methods
    This was a single-blind, randomized cross over clinical trial. Patients with ESRD were randomly allotted to two groups. All patients received placebo and C0- Q10 100mg/d during the three months in each stage, with two week washout period. Plasma level of CRP and homocysteine from the start of the work and at the conclusion of each menses, are evaluated.
    Results
    Thirty-four patients randomized, but 26 patients complete study protocol. The treatment effect of CO-Q10 on CRP level is significant (P < 0.001) (95% CI = -20.1 to -10.5) and it was also significant for the increasing albumin level. (P = 0.044) (95% CI = 0. 0-0.6), But there was not any substantial effect on serum homocysteine level (P = 0.630).
    Conclusions
    CO-Q10 could significantly decrease CRP level as an inflammatory marker and can protect cardiovascular events.
    Keywords: Homocysteine, C, reactive protein, Renal insufficiency, Coenzyme Q10
  • Babak Baharvand, Ahmadi, Mahmoud Bahmani, Pegah Tajeddini, Nasrollah Naghdi, Mahmoud Rafieian, Kopaei Pages 44-50
    Background
    Diabetes is the greatest public health problem and is considered as the silent epidemic of the 21st century. In Iran, there are approximately 1.5 million diabetic patients. Before the discovery of insulin, medicinal plants were widely used for the treatment of diabetes in Iran.
    Objectives
    This study aimed to determine the indigenous plants used for the treatment of diabetes in Shiraz, southwest of Iran.
    Materials And Methods
    Semi-structured direct interviews were conducted with 25 herbalists to identify medicinal plants used to treat diabetes. Questionnaires were included herbalist personal information, plant local name, growth season, plant parts used, preparation methods, and traditional therapies.
    Results
    The interview data indicated that, 24 medicinal plants from 19 families are used for the treatment of diabetes in Shiraz. The families with most antidiabetic species were Compositae (13%), Rosaceae (13%) and Cucurbitaceae (8%). The most frequently used plant parts were fruits (38%) and the most common preparation method was decoction (62%). For 45% of reported plants, pharmaceutical studies approved antidiabetic effects in animal or humane model of diabetes. Results of this study showed that the plants recommended by Shirazian herbalists have potential antidiabetic effects.
    Conclusions
    It is suggested that the ingredients of indigenous plants be studied to determine therapeutic effects and mechanism of action. If they were safe and effective, they can be refined and processed to produce natural drugs.
    Keywords: Medicinal plants, Diabetes mellitus, Hypertension
  • Shervin Assari Pages 51-59
    Background
    Kidney failure and associated mortality is one of the major components of racial disparities in the United States.
    Objectives
    The current study aimed to investigate the role of distal (socioeconomic status, SES), intermediate (chronic medical diseases), and proximal (health behaviors) factors that may explain Black-White disparities in mortality due to renal diseases. Patients and
    Methods
    This is a nationally representative prospective cohort with 25 years of follow up. Data came from the Americans’ Changing Lives (ACL) study, 1986 to 2011. The study included 3361 Black (n = 1156) or White (n = 2205) adults who were followed for up to 25 years. Race was the main predictor and death due to renal disease was the outcome. SES, chronic medical disease (diabetes, hypertension, obesity), and health behaviors (smoking, drinking, and exercise) at baseline were potential mediators. We used Cox proportional hazards models for data analysis.
    Results
    In age and gender adjusted models, Blacks had higher risk of death due to renal disease over the follow up period. Separate models suggested that SES, health behaviors and chronic medical disease fully explained the effect of race on renal disease mortality.
    Conclusions
    Black-White disparities in rate of death due to renal diseases in the United States are not genuine but secondary to racial differences in income, health behaviors, hypertension, and diabetes. As distal, intermediate, and proximal factors contribute to racial disparities in renal disease mortality, elimination of such disparities requires a wide range of policies and programs that target income, medical conditions, and health behaviors.
    Keywords: Ethnic groups, African Americans, Socioeconomic status, Hypertension, Diabetes, Obesity