فهرست مطالب
Journal of nephropathology
Volume:7 Issue: 4, Oct 2018
- تاریخ انتشار: 1397/06/10
- تعداد عناوین: 14
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Pages 224-232Context: Depression is a highly prevalent and debilitating mental disorder, particularly among patients under hemodialysis, who are more susceptible to depression due to their complex treatment regimens, dietary limitations, side effects of medications and fear of disease outcomes. This systematic review and meta-analysis explored the prevalence of depression in Iranian hemodialysis patients.
Evidence Acquisitions: In this systematic review and meta-analysis, search was done in national and international databases, including SID, MagIran, Google Scholar, Web of Science, Medline (via PubMed), and Scopus from inception to March 2018. Key search terms included hemodialysis, renal replacement therapy, dialysis, end-stage renal disease, renal failure, depression and Iran along with all their possible combinations. Data were combined for metaanalysis using random effects model. Heterogeneity between studies was analyzed by I2 test, and data were analyzed by STATA (version 12) software.ResultsThe included 24 articles had a sample size of 2941 participants; the overall prevalence of depression in hemodialysis patients in Iran was 56.8% (95% CI: 50.5-63). The results of the univariate meta-regression analysis showed no significant correlation between prevalence of depression and methodological quality of articles (P=0.524), duration of hemodialysis (P=0.885), publication year (P=0.116), mean age of participants (P=0.224) and sample size (P=0.194).ConclusionsMore than half of the hemodialysis patients in Iran suffer from depression. Given the overlap of depression symptoms with uremia in this group of patients, it is necessary to identify depression in these patients for early management and interventions.Keywords: Depression, Hemodialysis, Meta, analysis, Iran, End, stage renal disease, Renal failure -
Pages 233-240BackgroundRenal biopsy is the gold standard for the diagnosis and classification of lupus nephritis (LN). However, a consecutive biopsy can predict the clinical course and optimize the therapeutic strategies.ObjectivesTo compare the histopathological findings with clinical responses.
Patients andMethodsThirty patients with active LN were included. Renal biopsies were performed at the time of diagnosis and subsequently under clinical criteria according to consensus of Spanish Society of Nephrology. The response to treatment was defined as complete response, partial responder or non-responder. The histological change in second biopsy towards LN classes I, II or III/IV-C was defined as histological response (HR).ResultsIn initial renal biopsy, 28 (93%) patients showed proliferative LN; III-A or A/C (n; 7), IV-A or A/C (n: 19) and mixed; III⅟ (n; 2). LN class V was presented in two cases. The clinical response was; complete response (10%), partial response (20%), and non-response (70%). HR was manifested in 37% and non-histologic response in 63% of patients. Around 33% of patients with complete response/partial response showed active lesions in the consecutive renal biopsy.ConclusionsIn Colombian Caribbean, LN is aggressive and refractory to treatment. The consecutive renal biopsy allowed to demonstrate the persistence of the activity of the lesion in almost half of the patients, which may provide additional information to create better response criteria. The consecutive renal biopsy is a tool that allows improving the evaluation of the response to treatment in the LN.Keywords: Lupus nephritis, Renal Biopsy, Clinical Response, Consecutive renal biopsy -
Pages 241-247BackgroundParaoxonase 1 (PON1) is an enzyme attached to high density lipoprotein (HDL-C) which has antioxidant and anti-atherogenic activities.ObjectivesIn this study, we investigated the effects of alpha lipoic acid on PON1 activity, lipid profile and atherogenic index as well as correlation between PON1 activities and HDL-C in diabetic rats.Materials And MethodsThirty adult male rats were distributed in three experimental groups in this study. Control (group I), diabetic (group II) and diabetic animals treated with alpha lipoic acid (group III) group. Diabetes mellitus was induced in rats in groups II and III by a single dose of alloxan monohydrate (100 mg/kg; subcutaneous) and then treatment was performed with administration of alpha lipoic acid (100 mg/kg intraperitoneally) in group III for 6 weeks. Blood samples were collected from animals to measure the levels of triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL-C), HDL-C, PON1 activity and correlation the between HDL-C and atherogenic index by PON1.ResultsStatistical analysis showed that alpha lipoic acid significantly (PConclusionsThis study demonstrated that the administration of alpha lipoic acid can improve PON1 activity, lipid metabolism, atherogenic index and is able to reduce the risk of coronary artery diseases and atherosclerosis in diabetic rats.Keywords: Alpha lipoic acid, Diabetes mellitus, Rat, Paraoxonase 1, Atherogenic index, Lipid profile
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Pages 248-254BackgroundPre-implantation kidney biopsy is a diagnostic tool used for deciding whether to accept an expanded-criteria deceased donor graft. However, the study of histopathological lesions in renal compartments as prognostic factors for graft function and survival has led to conflicting results.ObjectivesThis study aimed to evaluate the presence of chronic lesions in pre-implantation kidney biopsies and correlate the findings with graft function and survival at 1, 3, and 5 years post-transplantation.
Patients andMethodsAround 430 kidney biopsies from standard and expanded-criteria deceased donors were analyzed between 2006 and 2013 at the hospital Santa Casa de Porto Alegre. Lesions were graded according to the Banff criteria. The glomerular filtration rate (GFR) was calculated by the CKD-EPI equation. Graft survival was calculated by the Kaplan-Meier method. Clinical variables related to graft outcome were assessed by Cox regression analysis.ResultsThe decrease in graft survival and function at the analyzed periods was related to a greater degree of chronic lesions in renal compartments. Glomerulosclerosis (GS) was an independent risk factor for graft loss.ConclusionsChronic lesions in any renal compartment should be taken into account in the clinical decision of accepting the kidney, but a greater weight should be given to GS. Kidney recipients with more than 25% GS had a less favorable outcome in our studyKeywords: Renal transplantation, Pre, implantation Biopsy, Graft Survival -
Pages 255-262BackgroundRenal disease is an important cause of morbidity and mortality in populations with HIV infection. Widespread use of combination antiretroviral therapy has altered the spectrum of renal disease. Studies among the HIV affected population in India are few.ObjectivesThe study was carried out to determine the various histopathological lesions in HIV patients with renal dysfunction, undergoing a renal biopsy, and to establish the clinico-pathological correlation. Patients andMethodsThirty HIV-positive patients, diagnosed by enzyme-linked immunosorbent assay (ELISA) method according to the National AIDS Control Organization (NACO) guidelines, undergoing a renal biopsy for renal dysfunction were studied. Descriptive statistics were applied.ResultsRather than the classic human immunodeficiency virus associated nephropathy (HIVAN) or a few prototypical lesions, the cases were spread across the entire spectrum of glomerular and tubulointerstitial pathologies described in the HIV population. A higher proportion of diabetic nephropathy, IgA nephropathy and chronic interstitial nephritis were encountered in the present study.ConclusionsIn the present scenario of increasing incidence of HIV infection, studying its various manifestations are relevant. As none of the clinical or laboratory variables are found to predict glomerular versus non-glomerular lesions on biopsy, a renal biopsy is indicated in renal dysfunction associated with HIV, to make an accurate diagnosis and for therapy.Keywords: Human immunodeficiency virus, Renal dysfunction, Renal biopsy, Histopathology
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Pages 263-267BackgroundIn hemodialysis patients, there are some oral hard and soft tissue changes.ObjectivesThe aim of this single-center, cross-sectional study was to evaluate oral findings in hemodialysis patients.
Patients andMethodsA total of 144 patients participated. Of them, 28 patients (19%) had diabetes mellitus (DM), 17 patients (12%) had systemic lupus erythematosus (SLE), and 15 patients (10%) had severe hypertension. The oral cavity was inspected by an oral medicine specialist using proper light, mirror and explorer. The lips, cheek, tongue, palatal mucosa, floor of the mouth, gingiva, pharyngeal fauces, dentures, teeth and occlusion were checked. The significance level was PResultsAround 78% of the studied population had oral manifestations. The most diagnosed finding in hemodialysis patients was dryness of the mouth followed by tooth loss due to mobility and poor oral hygiene. Diabetic cases showed numerous oral symptoms than nondiabetic subjects.ConclusionsOral lesions in hemodialysis patients is a prominent finding and untreated lesions may cause severe side effects.Keywords: Diabetes Mellitus, Oral hygiene, Oral lesion, Prevalence, Xerostomia -
Pages 268-272BackgroundOxidative stress and systemic inflammation is increased in end-stage renal disease (ESRD) patients. Due to the various effects of oxidative stress in ESRD patients, different antioxidants have been evaluated.ObjectivesIn this study, we evaluated the effect of oral N-acetylcysteine (NAC) as an antioxidant on the serum high-sensitive C-reactive protein (hs-CRP) and plasma hemoglobin levels in the ESRD patients who were under routine hemodialysis.
Patients andMethodsIn this randomized placebo-controlled clinical trial, 51 ESRD patients under routine hemodialysis were randomly assigned to receive NAC 1200 mg daily for 1 month (n=26) or placebo (n=25). Laboratory findings including hemoglobin, ferritin, hsCRP were measured in patients before and after treatment.ResultsNAC group compared to placebo group had significantly higher ferritin levels before treatment (p=0.02) and lower phosphorus levels after treatment (p=0.03). Comparing the results before and after treatment in each group, a significant reduction in hematocrit (p=0.002), ferritin (p=0.006), hs-CRP (p=0.02) and an increase in alkaline phosphatase levels (p=0.005) in NAC group and significant reduction in calcium levels (pConclusionsOne month treatment with oral NAC resulted in reduced levels of hematocrit, ferritin and Hs-CRP, indicative of role of NAC in controlling inflammation in ESRD patients under hemodialysis. However, NAC was not effective in treatment of anemia, although the treatment duration was low.Keywords: End, stage renal disease, high sensitivity CRP, N, acetylcysteine, Hemoglobin -
Pages 273-280BackgroundTranscription factor 7-like 2 (TCF7L2) acts as a downstream effector in the Wnt signaling pathway. It plays important roles in the proliferation and differentiation of islet betacell, insulin secretion and kidney development.ObjectivesThis study aimed to demonstrate whether rs7903146 variant is associated with diabetic nephropathy (DN) and measures of kidney function in a diabetic and healthy Arab population in southwest of Iran.
Patients andMethodsThis study is comprised of 132 diabetic subjects (T2DM) and 66 healthy participants. The diabetic subgroups were composed of patients with DN (n=56) and early onset of diabetes (n=71). The rs7903146 polymorphism was genotyped using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method in all the participants. Blood glucose, HbA1c, blood urea nitrogen (BUN), creatinine and urinary albumin were evaluated by a biochemistry analyzer and enzyme-linked immunosorbent assay (ELISA) was employed for cystatin C measurement.ResultsThe frequency of genotypes was significantly different between all the diabetic cases and control subjects (PConclusionsThe results confirmed that the TCF7L2 gene rs7903146 variants are significantly associated with T2DM in Arab population of Iran. The TT genotype of this SNP is also predisposed to the risk of developing DN especially in subjects with early onset diabetes. Patients with TT genotype were also at risk of decreased GFR.Keywords: Diabetic nephropathy, Glomerular filtration rate, Cystatin C -
Pages 281-285BackgroundObesity is an important problem associated with worsening cardiovascular disease and the progression of proteinuria in kidney transplant recipients. We describe a case of de novo focal segmental glomerulosclerosis (FSGS) associated with progressive obesity after kidney transplantation (KTx).Case PresentationA 41-year-old male patient underwent an allograft kidney biopsy because of nephrotic range proteinuria. The donor was his father who was aged 70 years at transplantation. In addition, there was a substantial difference in body weight (BW) between the recipient and donor. At 56 months after kidney transplantation, the patients BW increased from 83.1 kg (BMI, 29.3 kg/m2 ) before kidney transplantation to 93.9 kg (BMI, 33.1 kg/m2 ). An allograft biopsy showed glomerular hypertrophy and focal segmental sclerotic lesions with partial epithelial cell hyperplasia. The histologic diagnosis was FSGS, not otherwise specified (NOS) variant. A comparison between the kidney volume before and after kidney transplantation, evaluated using volumetric computed tomography, revealed prominent kidney hypertrophy (1.77 times).ConclusionsOur case demonstrated that de novo FSGS after kidney transplantation is induced by progressive obesity, as manifested by glomerular hypertrophy as well as kidney hypertrophy. This is a hyperdynamic state contributed to the pathogenesis of de novo FSGS. Our report is important to understand the pathogenesis of FSGS.Keywords: Focal segmental glomerulosclerosis, Obesity, Kidney transplantation, Kidney hypertrophy
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Pages 286-289BackgroundSignificant capillary proliferation is common in post-streptococcal acute glomerulonephritis (PSAGN) after streptococci and is a prognostic disease. Focal segmental glomerulosclerosis is a disease characterized by segmental sclerosis although it may have a poor prognosisCase PresentationA 50-year-old man with nephrotic syndrome underwent renal biopsy, which showed marked endocapillary proliferation due to enlarged vascular endothelial cells and infiltration of lymphocytes. However, there was no mesangial cell proliferation, mesangial matrix increase, or crescent formation. Electron microscopy showed fusion of podocytes without any electron-dense deposits. Immunostaining for CD68 and CD3 was positive, and the presence of macrophages and T-cells was suggested. Steroid therapy, including pulse therapy, was performed, and then cyclosporine was added to steroid therapy. Although urinary protein decreased, his renal function did not respond well to steroid therapy, and the patient initiated dialysis 2 years later.ConclusionsWe report this case considering that it was nephritis of unknown origin showing segmental endocapillary proliferation that had not been recognized previously.Keywords: Extracapillary proliferation, Renal failure, Steroid therapy
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Pages 290-292BackgroundGreat quantity of star fruit (Averrhoa carambola) ingestion, or even smaller amounts in a patient with an empty stomach, may induce acute kidney injury (AKI).Case PresentationWe report a 65-year-old male patient with underlying multiple myeloma and normal kidney function, who developed alterations of consciousness and rapid increase in serum creatinine due to oxalate nephropathy after large ingestion of star fruit on an empty stomach. Kidney biopsy revealed the diagnosis of oxalate nephropathy.ConclusionsAKI due to oxalate nephropathy after star fruit ingestion is relatively uncommon (only eight other reported cases) but there is an increasing evidence of AKI associated with intoxication by star fruit. This case alerts health professionals, nephrologists in particular, to a new disease that is increasingly better known and diagnosed more frequentlyKeywords: Averrhoa carambola, Star fruit, Oxalate, Oxalate nephropathy, Acute kidney injury
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Pages 293-295BackgroundOral facial digital syndrome (OFDS) is the name of a group of congenital diseases with involvement of face, oral cavity, digits and other organs. Renal involvement in OFD may be in form of polycystic kidney disease.Case PresentationThis case report presents a patient with OFDS who developed end-stage renal disease (ESRD) at age of six without evidence of renal cyst in sonography.ConclusionsIt may be recommended to evaluate and follow up renal function in children with cleft lip and cleft palate especially when they have other anomalies such as polydactyly and oral lesions considering possibility of OFDS.Keywords: Oral facial digital syndrome, End stage renal disease, Children
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Pages 296-300BackgroundAverrhoa bilimbi is a commonly used fruit in South India for various home preparations and as a traditional remedy for hypercholesterolemia and hypertension. As it belongs to Oxalidaceae family, fruit has high oxalate content, causing calcium oxalate crystal deposition in renal tubules, resulting in acute oxalate nephropathy (AON) when consumed in large quantities.
Case Series: We present a series of 24 patients from 11 hospitals in the State of Kerala who developed acute renal failure after some days of intake of Irumban puli fruit juice. Seven patients needed hemodialysis while the other three improved with conservative management.ConclusionsWe conclude that it is not safe to consume high oxalate containing fruits, especially in concentrated forms, that too in large quantities.Keywords: Acute oxalate nephropathy, Irumban Puli, Averrhoa bilimbi