[show abstract][hide abstract] ABSTRACT: BACKGROUND: Percutaneous coronary intervention provides a high-risk condition for incidence of CIN even in patients with normal renal function. Pentoxifylline (PTX) with a variety of mechanisms may prevent CIN. MATERIALS AND METHODS: Between April 5, 2011, and February 20, 2012, all consecutive eligible patients referred for elective percutaneous coronary intervention were asked to participate in the study (n = 199). Eligibility was defined as the age between 18 and 65 years and baseline serum creatinine ≤132.6 μmol/l (1.5 mg/dl). The patients were randomly allocated to two groups either receiving saline or saline plus pentoxifylline 400 mg orally three times a day for 48 h. Serum creatinine was measured 24 h prior to the procedure and 48 h thereafter. The primary endpoint was occurrence of CIN defined as 25 % rise in serum creatinine 48 h after the procedure. RESULTS: The overall incidence of CIN was 6 % in this study (6.2 % in the PTX group versus 5.9 % in the hydration group, P = 0.92). Absolute rise in serum creatinine was not also significantly different between the two groups (P = 0.97). In hypertensive patients, however, the incidence of CIN was lower among those receiving PTX: 5 % in the PTX group versus 8.7 % in the hydration group. Nevertheless, this difference was not statistically significant (P = 0.68). CONCLUSION: Short-term prophylaxis with pentoxifylline added to optimal hydration does not seem to reduce the risk of CIN in patients with normal renal function undergoing PCI. Further clinical trials in patients with renal impairment are warranted to define its role.
International Urology and Nephrology 04/2013; · 1.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: Depression is a common psychological symptom in patients undergoing chronic hemodialysis. In the general population, low serum zinc level is associated with major depression. The current study surveys the possible relationship between the prevalence of depression and plasma level of zinc in patients on hemodialysis (HD).
A total of 135 patients with end-stage renal disease (ESRD) on HD were enrolled in the study. The severity of depression was assessed using Beck Depression Inventory (BDI). Plasma zinc level was measured from fasting samples.
Mean age of the patients was 52.45 (standard deviation: 15.33) years. In all, 76% of the patients had some degree of depression according to BDI scoring system (BDI >14). The mean level of plasma zinc in the depressed patients was significantly lower than the rest of the patients (67.46 ± 29.7 vs. 85.26 + 40.05).
Zinc deficiency may be a reversible cause which might contribute to the increased rate of depression in HD patients. This is the first study reporting the association of zinc deficiency with the presence of depression in HD patients; therefore, these findings need further investigations.
Journal of Renal Nutrition 03/2011; 21(2):184-7. · 1.75 Impact Factor
[show abstract][hide abstract] ABSTRACT: Prospective studies have reported associations among various markers of inflammation and the incidence of diabetes, and it has been proposed that inflammation has a causal role in the development of diabetes. The objective of this study was to investigate the significance of serum and urine neuraminidase activity (NA) and serum and urine sialic acid (SA) level in patients with Diabetic nephropathy.
In a prospective study, 190 diabetic patients with established diabetic nephropathy, 30 type 2 diabetes patients without any diabetic related nephropathy, and 36 non-diabetic patients with diagnosed nephropathy were enrolled. Two hundred and forty healthy individuals without diabetes or kidney disease were also enrolled as control group. Fasting venous blood samples and urine samples were collected and checked for serum and urine NA and SA level.
In the diabetic nephropathy group, the mean value of serum and urine NA was 64.6 ± 2.6 and 11.7 ± 1.2 mU/ml, respectively, and mean values of serum and urine SA were 93.2 ± 3.6 and 17.7 ± 1.4 mg/dl, respectively. Serum and urine NA and SA levels were significantly higher in patient with diabetic nephropathy when compared to the other groups (P < 0.001).
Our study suggests that there is a strong association between elevated serum and urine NA and serum and urine SA levels with the presence of diabetic nephropathy in type 2 diabetic patients. Further investigations are needed on the diagnostic and prognostic significance of these two inflammatory markers.
International Urology and Nephrology 01/2011; 43(4):1143-8. · 1.33 Impact Factor
[show abstract][hide abstract] ABSTRACT: The incidence of accelerated atherosclerosis among patients on hemodialysis is very high and oxidative stress (OS) is a potentially major contributor to their morbidity and mortality.
To evaluate the effects of Silymarin and/or vitamin E on OS markers and hemoglobin levels in patients on hemodialysis.
Eighty patients on hemodialysis were randomized into four groups: Group 1 received silymarin 140 mg 3 times daily; Group 2 received vitamin E 400 IU/day; Group 3 received silymarin 140 mg 3 times daily and vitamin E 400 IU/day; and Group 4 was the control. Samples were obtained at baseline and on day 21 for measurement of malondialdehyde (MDA), red blood cell (RBC) glutathione peroxidase (GPX), and hemoglobin.
Combination of silymarin and vitamin E led to a reduction in the MDA levels (7.84 ± 1.84 vs. 9.20 ± 2.74 nmol/mL; p = 0.008). There was a significant increase in RBC GPX levels in all treatment groups compared with controls after 3 weeks. This was more pronounced in the group receiving combination compared with the group receiving vitamin E or the control group (5.78 ± 3.51, 4.22 ± 1.63, and 3.16 ± 1.89 IU/grHb, respectively; p < 0.001). There was also a significant increase in mean hemoglobin of all treatment groups compared with the control.
Oral supplementation with silymarin and vitamin E leads to reduction in MDA, increase in RBC GPX, and increase in hemoglobin levels in patients with end-stage renal disease. Studies with larger sample sizes and longer follow-up are required to investigate the effect of silymarin on cardiovascular outcomes and erythropoietin requirement.
[show abstract][hide abstract] ABSTRACT: Senior-Loken syndrome is a rare entity that combines familial juvenile nephronophthisis with retinal dystrophy. Herein, we report Senior-Loken syndrome in six members of an Iranian family with progressive blindness and renal failure since childhood. Although, this syndrome was reported from other parts of the world, report of six members of one family with this syndrome is rare. To the best of our knowledge, this is the first report from Iran.
Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 07/2010; 21(4):735-7.
[show abstract][hide abstract] ABSTRACT: Sexual dysfunction in chronic renal failure patients undergoing hemodialysis is common. It is demonstrated that the zinc level is significantly lower in the hemodialysis patients.
In this clinical trial, we investigate the effect of zinc supplement therapy on the serum levels of sexual hormones in hemodialysis male patients.
We carried out a clinical trial study including 100 of our male patients with end-stage renal disease on hemodialysis. Testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and zinc plasma level were measured in all of the patients. The patients received zinc supplement (zinc sulfate, 250 mg/day) for 6 weeks, and sex hormones and zinc plasma level were checked again.
Serum level of FSH and prolactin did not have any significant changes before and after intervention, but serum level of testosterone, LH, and zinc increased significantly.
These results suggest that although zinc administration did not have a definite effect on hemodialysis patients with sexual dysfunction, it can cause increase in the serum level of sex hormones which may improve the sexual function of the patients in some aspects.
[show abstract][hide abstract] ABSTRACT: Background: Patients with panel reactive antibodies (PRA) have many difficulties to find a crossmatch-negativekidney for transplantation and are at a higher risk of post-transplantation rejection.Objective: To evaluate the effect of simvastatin on PRA and post-transplant outcome of these sensitized patients.Methods: 82 patients with end-stage renal disease (ESRD) with a PRA ≥25% were evaluated. In a one-year follow-up, the patients were treated with simvastatin. These patients were compared with 82 matched controlsreceiving placebo tablets. At the end of the second and 12th month, PRA was rechecked in all patients. Those patients who underwent transplantation continued to take simvastatin six months after transplantation.Serum creatinine levels were checked at monthly intervals post-operation.Results: The mean±SD PRA level at the end of the second month was 36.63%±31.14% and 45.34%±24.36% in cases and controls, respectively (P=0.012). Seven patients in the case group and 10 in the control group were lost to follow-up. The remaining patients continued to take simvastatin for 12 month.The mean±SD PRA level at the end of the 12th month was 24.02%±31.04% in cases and 43.15%±26.56% in controls (P=0.001). 25 patients underwent renal transplantation and continued to receive simvastatin 6 months after transplantation. These patients were matched with 25 controls treating with placebo. The mean±SD creatinine level 6 months after kidney transplantation was 2.05±1.14 mg/dL and 3.15±1.09 mg/dL in cases and controls consecutively (P=0.02).Conclusion: Simvastatin can be safely used to lower PRA and improve post-transplantation outcomes.
International Journal of Organ Transplantation Medicine. 01/2010;
[show abstract][hide abstract] ABSTRACT: Background: Acute renal failure requiring renal replacement therapy after cardiac surgery is still a cause ofmajor morbidity and mortality worldwide. A number of risk factors for the development of acute renal injury aftercardiac surgery have been previously described and based on these variables; several scoring algorithms wereproposed. Predictive value of these algorithms in Iran is not described. This study investigates these risk factorsamong our patients in southern Iran.Methods: Two hundred and forty patients with normal kidney function who were candidates for cardiac surgerywere enrolled and their baseline data were collected. Diabetes mellitus and age were selected as more controversialpreoperative risk factors. Clamp and pump time were also selected as intra-operative risk factors and thetype of operation was also considered as an independent risk factor. The patients were categorized in twogroups including group 1: Patients with post-operation normal kidney function and group 2: Patients with postoperationARF. All patients were followed with serial measurement of serum creatinine post-operation.Results: The incidence of acute renal failure was 11.25%. Mean age of the patients in group 1 was 54.24±15.88and in group 2 was 52.85±18.20 years. There was not any significant correlation between duration of clamp timeand post operation acute renal failure. Clamp time in group 1 was 51.49±11.88 and in group 2 was 53.48±13.40min. Duration of pump time in group 1 was 63.31±12.56 min and in group 2 was 78.07±10.85 min. The differencewas statistically significant. Forty two (20%) of the patients in group 1 and 13 (50%) in group 2 were diabetic.Conclusion: Although several scoring algorithms are available for prediction of post-cardiac surgery complications,these can also be matched with our patients’ criteria enhancing their accuracy for our situation.
[show abstract][hide abstract] ABSTRACT: Chronic kidney disease is a worldwide health problem. Type II diabetes mellitus is now a major cause of end stage renal disease. The effect of diabetes mellitus through the dysregulation of the innate immunity results in increased tumor necrosis factor-alpha. This can lead to an increasing protein trafficking through the glomerular capillary, which can have an intrinsic renal toxicity. Seventy-four patients with type II diabetes mellitus with overt proteinuria were included in the study. They were randomly assigned to two groups of 37 patients (group 1: captopril 25 mg three times a day, group 2: captopril 25 mg and pentoxifylline 400 mg each three times per day). In the course of the study, two patients were excluded from each group. Daily urinary protein excretion was assessed at baseline and at two and six months. The reduction of urinary protein to creatinine clearance ratio in group 2 was 15.16 points more than in group 1 from baseline to the end of the study (p = 0.001). The difference in reduction only started after two months of pentoxifylline use. The differences in HbA1c and duration of diabetes mellitus at baseline in the two groups had not adversely affected the outcome of the study. There was a modest decrease in systolic blood pressure in group 2 as well (p = 0.041). Combining an angiotensin-converting enzyme inhibitor and pentoxifylline can lead to a greater reduction in proteinuria.