hounaz akbari

Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary kidney disease that can affect several organs. The clinical course of the disease varies among patients; some never become symptomatic, and others reach end-stage kidney disease (ESKD) in the 5th decade of their life.

This historical cohort study was conducted on ADPKD patients to investigate kidney and patient survival rates and related risk factors in Iran. Survival analysis and risk ratio calculation were performed using the Cox proportional hazards model, Kaplan– Meier method, and log-rank test.

Among the 145 participants, 67 developed ESKD, and 20 died before the end of the study period. Developing chronic kidney disease (CKD) at the age of ≤ 40, baseline serum creatinine level (SCr) of more than 1.5 mg/dL, and cardiovascular disease increased the risk of ESKD by 4, 1.8, and 2.4 times; respectively. Patient survival analysis revealed a fourfold increase in mortality if the glomerular filtration rate (GFR) declined more than 5 cc/min annually and if CKD was diagnosed at the age of ≤ 40. Vascular thrombotic events or ESKD in the course of disease increased the risk of death by approximately 6- and 7-fold, respectively. Kidney survival was 48% by the age of 60 and 28% by the age of 70. Patient survival was 86.05% at the age of 60 and 67.99% at the age of 70. Additionally, men had a significantly better renal function and survival than women.

Elevated baseline SCr and cardiovascular disease can increase ESKD risk in ADPKD patients. A rapid decline in GFR, ESKD development, and vascular thrombotic events increase the risk of death, but early CKD can affect both.

Chronic obstructive pulmonary disease (COPD) and heart failure are prevalent comorbidities affecting a vast proportion of the world population, responsible for significant morbidity and mortality, their coexistence is more frequent than previously recognized that poses important diagnostic and therapeutic challenges. We intend to determine the prevalence of concomitant left ventricular dysfunction in COPD patients. We performed a cross-sectional study in patients who had referred to Firuzgar University Hospital in Tehran from March 2011 to March 2013 in period of 2 years. All participants were compatible for including and excluding criteria’s. In all cases of COPD, pulmonary function test was done; also Echocardiography was performed as the diagnostic assessment of heart failure. Out of 74 participants there was 56(75.7%) male and 18(24.3%) female with the mean age of 67.712.9 (SD), the prevalence of left ventricular systolic dysfunction (LVSD) was 25.70%, also the prevalence of left ventricular diastolic dysfunction (LVDD) was 74.60% among 71 patients. The prevalence of LVSD in patients with and without history of coronary artery disease (CAD) was 33.30% and 15.60% respectively. The prevalence of LVDD was 85.40% in patient with history of CAD and 60% in patients without it. The presence of ventricular dysfunction (neither systolic nor diastolic) in COPD patients was not statistically associated with presence of CAD or the intensity of underlying COPD disease. Knowledge about the prevalence of concomitant left side heart failure in COPD patients is limited, but it seems the presence is rather common, so more attention should be paid to coexistence of ventricular dysfunction in COPD patients disregarding presence of CAD or COPD intensity in clinical practice.

Hypoparathyroidism might cause various musculoskeletal findings, resembling Spondyloarthropathies. We described a 52-year-old woman, diagnosed as a case of undifferentiated spondyloarthropathy for ten years, who was unresponsive to classic anti-inflammatory therapies. She developed anterior ischemic optic neuropathy and had elevated muscle enzymes during the course of disease. On a routine checkup, marked hypocalcemia and suppressed parathyroid hormone levels were found. Calcium and calcitriol therapy led to clinical and laboratory improvement. This case emphasizes the importance of recognizing rheumatic manifestations of hypoparathyroidism to preclude unnecessary treatments. Serum calcium should be included in the diagnostic workup of these patients.