[Show abstract][Hide abstract] ABSTRACT: Various strategies have been applied to improve the response to hepatitis B virus (HBV) vaccination in hemodialysis patients.
The present study was under taken to compare the seroconversion rate of hemodialysis patients who had not respond to 3 intramuscular (IM) doses (40 μg each) of HBV vaccine , after a fourth IM dose (40 μg) of HBV vaccine that was administered alone or with subcutaneous granulocyte-colony stimulating factor (G-CSF) (5 μg/kg).
Twenty six hemodialysis patients who had not responded to 3 IM injections of HBV vaccine were randomized into 2 groups: Group 1 received a booster dose of 40 μg HBV vaccine IM, group 2 received a booster dose of 40 μg HBV vaccine IM plus 5 μg/kg subcutaneous G-CSF. Antibody to hepatitis B surface antigen was measured 1 month after the booster dose.
Seroconversion rate in group 1 was 40%. There was a trend towards a higher seroconversion rate at 60% in group 2 patients; however, because of the small number of patients it did not reach statistical significance.
Larger number of patients and other innovative strategies should be applied for vaccination of this group of patients. More prolonged follow up of the patients is needed to evaluate the duration of protection induced by each method of vaccination.
[Show abstract][Hide abstract] ABSTRACT: The aim of this cross-sectional study was to assess the health status and quality of life (QOL) of paid unrelated versus related living kidney donors postdonation at Shiraz Transplant Center in Iran. We invited all donors (n = 580, 347 paid unrelated, 233 related) who underwent donor nephrectomy at our center from 2004 to 2010 to participate in a health survey and physical examination. Of 580 donors, 144 consented to participate; participation of paid unrelated donors was significantly lower than related (52/347 vs. 92/233; p < 0.001). Participants underwent a complete physical examination, QOL assessment (using a 36-item short form health survey [SF-36] questionnaire) and laboratory work-up. The paid unrelated donors compared with related donors were younger (34.2 ± 7.2 vs. 40.7 ± 9.7 years, p < 0.001), had shorter time since donation (2.9 ± 1.6 vs. 3.8 ± 2 years, p = 0.004), had higher estimated GFR (72.6 ± 22 vs. 63.8 ± 15.3 mL/min/1.73 m(2) , p = 0.006) and had a higher percentage of patients with microalbuminuria (35% vs. 0%, p < 0.001). Additionally, general health and social functioning scores among paid unrelated donors were significantly lower (p < 0.001 and p = 0.02, respectively) than related donors. Other SF-36 scores, although lower in paid unrelated donors, did not reach statistical significance. Iranian paid unrelated donors have lower QOL and higher incidence of microalbuminuria compared with related donors.
American Journal of Transplantation 12/2013; 13(12):3210-3214. DOI:10.1111/ajt.12488 · 5.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cytokines are important factors determining the outcome of transplantation. Since host ability in cytokine production may be affected by cytokine genes polymorphisms. The aim of the present study was to investigate the effect of IL-17, IL-23R and IL-21 gene polymorphisms in outcome of kidney transplantation. A total of 250 kidney transplant recipients were included in this study. Over all 70 recipients (28%) experienced an acute rejection. IL-17 197 A/G, IL-21 +1472G/T, IL-21 5250 C/T, and IL-23R C/T gene polymorphisms were evaluated by PCR-RFLP or ARMS-PCR methods. The serum levels of IL-17 and IL-21 were also checked by ELISA. IL-17 GG carriers and G allele were significantly more frequent in patients with acute rejection compared to patients without any sign of rejection (p=0.045 and p=0.032, respectively). In addition after gender classification, IL-23R AA carriers and A allele were significantly more frequent in male patients experienced an acute rejection compared to non-rejected patients (p=0.03, p=0.011, respectively). The IL-17 serum levels have also shown a significant differences between rejected and non-rejected group (24.37±32.94 for AR and 8.6±9.9 for non-AR groups, respectively; p=0.035). The mentioned results indicate that IL-17GG genotype, G allele and its serum level have predictive values for acute rejection. GG genotype and G allele of IL-17 is a genetic risk factor for development of acute rejection. Also, AA genotype and A allele of IL-23R is a sex dependent genetic risk factor for development of acute rejection, but this subject need to be studied in different population.
[Show abstract][Hide abstract] ABSTRACT: This study aimed to assess the psychometric properties of the Persian version of the Ferrans and Powers 3.0 quality of life index (dialysis type) in patients receiving hemodialysis (HD) in order to describe their health-related quality of life (HRQOL).
The sample (n = 150) consisted of adult HD patients receiving HD for at least 6 months from the establishment of the study. A total of 88 men and 62 women, with an average age of 50.47, from Shiraz, southern Iran, were enrolled in this study. The questionnaire was translated into Persian language using back translation and bilingual techniques. Convergent, discriminant, and construct validity of the Ferrans and Powers 3.0 dialysis version was evaluated. To check the internal consistency of the data, Cronbach's alpha, which indicates the reliability of the data, was used for the entire questionnaire and for the subscales.
The convergent and discriminant validity and success scaling rate for both sexes were 100 %. Cronbach's alpha was 0.95 overall, which was greater than 0.7 for all the subscales except for the family subscale. Our results suggest that HD patients in southern Iran have higher HRQOL scores when compared with those in other countries. Despite the higher mean HRQOL score for men compared with women, men had significantly higher HRQOL scores only in the health and functioning subscale. There was no significant correlation between HD patients' HRQOL and educational level.
The Persian version of Ferrans and Powers 3.0 has sufficient reliability and validity for measuring the quality of life of Persian-speaking HD patients. Female HD patients need more support and attention from family and society.
International Urology and Nephrology 08/2013; DOI:10.1007/s11255-013-0537-5 · 1.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Metabolic complications are common after kidney transplantation and can cause considerable morbidity and even threaten graft function. This study aimed to investigate the prevalence of hyperlipidemia and its impact on graft function in 10 years of follow-up of patients undergoing kidney transplantation.
This prospective study was conducted on 73 patients who underwent kidney transplantation between April 1996 and April 1998 to evaluate their lipid profile and graft function as well as the effect of hyperlipidemia in long-term kidney allograft function. Kidney allograft dysfunction was defined as a serum creatinine level greater than 1.8 mg/dL.
The mean serum triglyceride level was higher at 1, 3, 5, and 10 years, but not 7 years, among patients with graft dysfunction in comparison with patients with normal graft function. However, these differences were not significant. The mean serum total cholesterol level was significantly higher in patients with graft dysfunction at 1 year (P = .03). Of the patients with graft dysfunction, 94.7% developed hypercholesterolemia at the first year visit, as compared to 70.4% of patients with normal graft function (P = .03). The frequency of hypercholesterolemia was higher among those with a serum creatinine greater than 1.8 mg/dL at all other visits, but without significant difference.
Hyperlipidemia is common after kidney transplantation, especially in the first year after transplantation. Higher serum total cholesterol levels might be related to graft dysfunction.
[Show abstract][Hide abstract] ABSTRACT: Thiopurine S-methyltransferase is an enzyme that catalyzes S-methylation of azathioprine as an immunosuppressive drug. Genetic polymorphisms influence thiopurine S-methyltransferase activity. There are 3 variant alleles: thiopurine S-methyltransferase*2, *3A, and *3C are responsible for more than 95% cases of low-enzyme activity.
We studied these polymorphisms and the occurrence of azathioprine adverse effects in 50 renal transplant recipients undergoing triple immunosuppressive therapy including azathioprine, cyclosporine, and prednisone. Thiopurine S-methyltransferase genetic polymorphism was determined by polymerase chain reaction restriction fragment length polymorphism assay and allele-specific polymerase chain reaction methods. Azathioprine dosage; leukocyte, erythrocyte, and platelet counts; and graft rejection episodes were analyzed during hospitalization.
Two patients (2%) were heterozygous for thiopurine S-methyltransferase*3C, the remaining patients were thiopurine S-methyltransferase wild-type *1/*1 (98%). Thiopurine S-methyltransferase wild-type homozygous and heterozygous patients were administered similar azathioprine dosages at the beginning of treatment (2.42 ± 0.50 and 2.52 ± 0.40 mg/kg/24 h). During subsequent days, mean azathioprine dosage administered to thiopurine S-methyltransferase wild-type homozygous patients was similar to heterozygous patients, but with no statistical difference (P = .28). Three patients had an acute rejection episode during this time. Five patients (10%) had reduced azathioprine dosage owing to adverse effects. Adverse reactions consisted of hematotoxicity (n=2), hepatotoxicity (n=1), and gastrointestinal toxicity (n=2). All recipients were wild-type homozygotes.
The frequency of thiopurine S-methyltransferase gene mutations is low among our patients. The incidence of adverse reactions to azathioprine was also low, even in patients carrying a variant of thiopurine S-methyltransferase. We conclude that determining thiopurine S-methyltransferase genotype is not useful in our population to predict adverse reactions to azathioprine.
[Show abstract][Hide abstract] ABSTRACT: Background: Nitric oxide (NO) is a major mediator in vascular biology, regulating regional blood flow. NO and the enzymes required for its production contribute to ischemia-reperfusion injury. The T-786C functional polymorphism in the promoter region substantially reduces promoter activity of the endothelial nitric oxide synthase (eNOS) gene and compromises endothelial NO synthesis.
Objective: To examine the association between T-786C (rs 2070744) single nucleotide polymorphism (SNP) in eNOS gene and the development of acute rejection in renal transplant patients.
Methods: 60 renal transplant recipients (30 with episodes of acute rejection (ARs) and 30 without rejection (non-ARs)), between June 2008 and March 2010, were included in this study. The polymorphism was determined by PCR-restriction fragment-length polymorphism analysis.
Results: The distribution of the genotypes were TT/TC/CC 60%, 33.4%, 6.6%, and 43%, 46.7%, 13.3% in ARs and non-ARs, respectively (p=0.28). The frequency of T-allele was 76.7% and 66.3%; and for C-allele was 66.6% and 33.3% in ARs and non-ARs, respectively (p=0.09). There were no significant associations between these polymorphisms and acute and chronic kidney allograft rejection.
Conclusion: We could not detect any significant association between polymorphism in T-786C of eNOS gene and the development of acute rejection.
International Journal of Organ Transplantation Medicine 05/2011; 2(2).
[Show abstract][Hide abstract] ABSTRACT: Venomous animal bites are a significant health problem for rural populations in many parts of the world. Herein, we report an unusual presentation of Echis carinatus sochureki bite from southern Iran. A 36 year old woman was referred to Shiraz Nemaze Hospital due to anuria, headache, gastrointestinal bleeding, nausea and vomiting and severe abdominal pain after Echis carinatus sochureki bite. According to the clinical and paraclinical evaluations, the patient was admitted with impression of acute renal failure and acute pancreatitis. Acute pancreatitis is a rare complication after snake bite. This article is the first report of acute pancreatitis after Echis carinatus sochureki bite.
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION. This study aimed to compare outcomes of kidney transplantation in patients with systemic lupus erythematosus (SLE) and a matched control group of non-SLE kidney recipients. MATERIALS AND METHODS. In a case-control study, 33 patients with kidney transplantation due to end-stage renal disease caused by SLE were matched to a control group consisted of 33 non-SLE patients who had been transplanted during the same period of time in our center. The clinical characteristics, complications, and patient and graft survival were compared between the two groups. RESULTS. In each group, 12 patients (36.4%) received a kidney from a deceased donor, 15 (45.4%) from a living unrelated donor, and 6 (18.2%) from a living related donor. There was no significant difference between the outcome in SLE patients and duration of dialysis before transplantation. The mean duration of hospital stay was 23.4 ± 18.1 days in the SLE group, while it was 13.0 ± 7.3 days in the controls (P = .006). One-year graft survival was 79.0% in patients with SLE and 90.9% in non-SLE patients (P = .17). One-year patient survival was 93.9% in patients with SLE versus 81.8% in the controls (P = .26). Nine patients in the SLE group versus 11 patients in the control group developed posttransplant complications (P = .59). CONCLUSIONS. Although hospital stay after transplantation was longer in the SLE kidney recipients than controls, safety of kidney transplantation was comparable. Graft failure in the SLE patients was not significantly different between patients with different sources of kidneys.
[Show abstract][Hide abstract] ABSTRACT: Background: Patients with panel reactive antibodies (PRA) have many difficulties to find a crossmatch-negative kidney 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 controls receiving 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 05/2010; 1(2).
[Show abstract][Hide abstract] ABSTRACT: Generalized pruritus is a significant complication in end-stage renal disease patients. The mechanism is unknown and most treatments are ineffective. This study is the first clinical trial designed to evaluate the effect of cromolyn sodium (CS) on renal itch.
Sixty-two haemodialysis (HD) patients with pruritus were enrolled into the study and were randomly assigned to receive CS or placebo (135 mg three times daily) for 8 weeks. Patients were asked to record the severity of their pruritus on each dialysis session on a visual analogue scale (VAS) during the 8 weeks of treatment and 4 weeks following discontinuation of treatment. Serum tryptase levels were determined at baseline, after 8 weeks of treatment and 4 weeks after discontinuation of treatment.
Data were analysed in 21 patients in the CS group and 19 patients in the placebo group that completed the study. A significant difference was seen in the severity of pruritus between the two groups during the period of study. Level of pruritus decreased from 8.48 +/- 2.2 to 0.9 +/- 1.8 after 8 weeks of treatment with CS. Geometric mean of serum tryptase at baseline and 8 weeks after treatment were 21.3 and 19.5 ng/ml for the CS group and 18.03 and 18.2 ng/ml for the placebo group, respectively. Although the geometric mean of tryptase had decreased in the CS group, this decrease was not statistically significant (P = 0.214).
CS can significantly reduce the severity of pruritus in HD patients, but this effect is not due to a decrease in serum tryptase level.
[Show abstract][Hide abstract] ABSTRACT: Due to the shortage of organ donations and the rising number of patients with terminal renal insufficiency, living donor kidney donation has become increasingly important during recent years. Hand-assisted laparoscopic living donor nephrectomy (LLDN) is an alternative to the conventional open approach and may decrease the surgical trauma to the donor. The aim of this study was to report our experience with this technique.
We reviewed demographic data, operative duration, hospital stay, and postoperative complications among 100 LLDNs performed from August 2006 to July 2008. We also performed a retrospective analysis of chemical and biochemical data of recipients.
Thirty female and 70 male subjects of mean age of 35.88 +/- 12.21 years were operated on during this period. The mean operative time for donor nephrectomy was 138.30 +/- 31.92 minutes (range 60-205) and for recipients, 87.66 +/- 11.79 minutes (range = 75-120), with a mean warm ischemia time of 5.19 +/- 1.76 minutes (range = 2-8). The donors' mean hospital stay was 28.34 +/- 8.31 hours (range = 24-72). Five donor operations were converted to open nephrectomy because of uncontrolled bleeding or abnormal anatomy. There was no need for blood transfusions or reoperations in the donors. Mean hospital stay for the recipients was 9.44 +/- 3.61 days (range = 5-22). Creatinine and blood urea nitrogen decreased from preoperative values of 10.46 +/- 3.73 and 66.10 +/- 25.16 to 1.39 +/- 0.38 and 29.64 +/- 8.83 mg/dL at discharge. The renal graft was rejected in two cases due to immunologic causes without any response to therapy. There was no vascular thrombosis in the transplanted kidneys.
LLDN is a viable alternative to the standard open nephrectomy. It may have a positive impact on the donor pool by minimizing disincentives to living donation. The results of our program were acceptable; this approach may be the procedure of choice in the future in our center.
[Show abstract][Hide abstract] ABSTRACT: We examined the effects of zinc supplementation on serum zinc and C-reactive protein concentrations in hemodialysis patients.
This was a randomized, double-blinded, placebo-controlled clinical trial.
This study was conducted at the Shahid Faghihi and Namazi Dialysis Centers in Shiraz, Iran.
Fifty-five hemodialysis patients (32 men and 23 women) participated after meeting the following criteria: zinc deficiency, treated for a minimum of 6 months; no record of hospitalizations in the preceding 3 months; and hemodialysis treatment 2 to 3 times per week.
Patients were randomly divided into two groups. The zinc supplementation group (n=28) received a 220-mg zinc sulfate capsule, and the control group (n=27) received a placebo capsule (220 mg corn starch), for 42 days.
Fasting, predialysis serum samples were collected on days 0 and 42 to determine serum zinc and C-reactive protein levels.
After supplementation, subjects in the zinc-supplemented group showed significant increases in serum zinc concentrations, from 57.4+/-2.4 microg/dL SEM on day 0 to 88.4+/-4.8 microg/dL SEM on day 42. Serum C-reactive protein concentrations were initially high among subjects in the control (15.1+/-3.9 mg/L SEM) and zinc-supplemented (13.5+/-3.8 mg/L SEM) groups. Serum C-reactive protein concentrations in the control group increased throughout the study period, but did not reach statistical significance. A progressive decrease in serum C-reactive protein concentrations was observed in the zinc-supplemented group from the beginning (13.5+/-3.8mg/L SEM) to the end (10.5+/-3.5mg/L SEM) of the study, but this event was not significant.
Zinc supplementation intake may cause an increase in serum zinc concentrations, leading to a decrease of inflammation in hemodialysis patients.
[Show abstract][Hide abstract] ABSTRACT: Lemierre syndrome is an entity defined by septic thrombophlebitis of the internal jugular vein following an oropharyngealinfection, which is usually acute and complicated by metastatic infection in different organs. Theusual causative organism is Fusobacterium necrophorum. On looking back at the case reports of Lemierre syndrome,we have found different sites of primary infection and also different presentations depending on the primarysite and the site of involvement resulting from metastatic septic embolization. However, chronic otitis mediaas the primary site of infection and bloody diarrhea as the presenting symptom were very rarely presented. Thecase presented here was referred to Faghihi hospital of our academic medical center with bloody diarrhea. Afterwork ups, the patient was diagnosed as a case of Lemierre syndrome on the base of chronic otitis media.
[Show abstract][Hide abstract] ABSTRACT: Anabolic androgenic steroids are widely used by athletes for increasing their muscle mass. These drugs are also used by some patients with chronic renal disease. But the effect of these drugs on the renal structure has received less attention. To investigate which parts of the kidney are affected by these drugs, mice kidneys were studied stereologically after injection of nandrolone decanoate (ND), an anabolic androgenic steroid. The treated group received nandrolone decanoate intraperitoneally (solved in olive oil) in doses of 3mg/kg of body weight and administered in one, two and three doses, respectively, in the first, second and third week of treatment. The mice in the control group received an olive oil solution. One week after the last injection, the mice were anaesthetized and their kidney removed. The analysis of data revealed that the weight of kidney was increased approximately 30% (p < or = 0.006) and its volume increased approximately 25% (p < or = 0.02) in ND treated mice in comparison with the control group. The volume of the cortex increased in ND treated animals approximately 44% (p < or = 0.006). Proximal convoluted tubules (PCT) and distal convoluted tubules (DCT) volume increased approximately 25% (p < or = 0.02) and approximately 68% (p < or = 0.02) in ND treated mice. The volume of glomeruli, other ducts, connective tissues, vessels and the length of PCT, DCT, collecting and Henle's ducts and vessels did not show significant differences. CONCLUSION: ND can increase the volume of the renal cortex and its two main parts, i.e. PCT and DCT in mice.
[Show abstract][Hide abstract] ABSTRACT: Data regarding the socioeconomic status in Iranian kidney transplant (KT) recipients is lacking. In this cross sectional descriptive study we evaluated the socio-economic status of 100 KT recipients in Shiraz organ transplantation center. In a cross-sectional design, we randomly selected and interviewed 100 RT recipients (50 males and 50 females). Data regarding age, gender, martial status, occupation, level of education, number of children, type of insurance, monthly household income, place of residence, ownership of a personal transportation device, duration and frequency of pre-transplant dialysis, family history of CRF (Chronic renal failure), and etiology of renal disease were obtained. There were 50 (50%) patients aged between 16 and 35 years, 55 had a family history of CRF, 60 had been on dialysis for more than a year, 61 were married, 47 did not have any children, 41 had more than 3 children, and 65 were unemployed due to physical and emotional impairment as a result of their disease. The majority (73%) did not have a high school diploma, 15% were illiterate, 85% were below the poverty line, 52% were from rural areas, and 98% were covered by insurance. We conclude that patients with CKD in our study had acquired this condition possibly due to negligence and lack of basic health care in the lower socioeconomic class. In addition, KT is an available therapeutic modality to lower socio-economic level in Iran.
Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 04/2008; 19(2):286-90.