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Introduction: Cardiovascular disease is a major factor in the deterioration of the health and the death of hemodialysis patients. Previous studies have mainly shown a decreased level of heat shock protein 27 (HSP27) in patients with cardiovascular disease. We conducted this study to investigate whether HSP27 correlates with common carotid intima-media thickness (CCIMT) and if it has a potential to be a biomarker for cardiovascular disease. Materials and Methods: In this cross-sectional study, the correlation between HSP27 serum concentration and CCIMT was investigated in 42 hemodialysis patients. An enzyme-linked immunosorbent assay method was used to measure HSP27 level in the plasma of the patients, and a high-resolution B-mode ultrasonography was applied to measure CCIMT. Results: There was an inverse significant correlation between serum concentration of HSP27 and CCIMT only in patients that had hypertension as their only cardiovascular risk factor (r = - 0.61, P = .02). Conclusions: According to our results and the fact that HSP27 has been shown to be expressed in atherosclerotic plaques of both experimental animals and humans, we suggest that circulatory HSP27 concentration has a potential of being used as a marker for cardiovascular events. [ABSTRACT FROM AUTHOR]

Chronic inflammation in dialysis patients increases the production of cytokines such as TNF-[alpha], IL-1[beta] and IFN- IFN-[gamma] and there is evidence of a significant mortality rate in dialysis patients due to inflammation. Overproduction of inflammatory cytokines can induce complications such as atherosclerosis, malnutrition and anaemia, which are mostly resistant to erythropoietin treatment. Cardiovascular disease is the leading cause of death in haemodialysis patients and about half of the mortality is attributable to cardiovascular disease. Silymarin modulates the immune system by inhibition of neutrophil immigration, mast cell immobilization, prostaglandin production and leukotriene synthesis. Furthermore, silymarin suppresses the induction of TNF-[alpha] and it was hypothesized that silymarin could decrease the serum concentration of TNF-[alpha] in peritoneal dialysis patients, and thus treat anaemia. Fifteen peritoneal dialysis patients were enrolled in this study and serum levels of soluble TNF-[alpha] were measured using an enzyme-linked immunosorbant assay (ELISA) kit. Serum TNF-[alpha] was found to be decreased in some patients and in the response group, the haemoglobin concentration after 8 weeks of silymarin administration was increased significantly (p < 0.05). Based on the results of this study, it is suggested that silymarin may be useful in the treatment of inflammation for peritoneal dialysis patients. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Gender discrimination in benefiting from medical treatment is a worldwide pro-blem. Kidney transplantation, as the ideal treatment for patients with end-stage renal disease (ESRD), is not an exception. Considering the unique kidney donation patterns and different family styles in the Middle East, studying this problem in Iran seemed justifiable and necessary. In addition to comparing the numbers of female and male recipients, which has been done in other similar studies, considering the critical effect of waiting time on the outcome, we assessed and compared the waiting times also. The data of age, gender, nationality, donor type and waiting time before transplantation of 1426 (61.85% male, 38.14% female) recipients who underwent transplantation in Imam Reza Hospital in the northeast of Iran from 1990 to 2003, was analyzed. Recipients were categorised into three groups based on donation patterns: those receiving kidney from live unrelated, live related and cadaver donors. The number of patients in each group was 1057 (61.96% male, 38.03% female), 232 (67.24% male, 32.75% female) and 137 (51.82% male, 48.17% female) respectively. The mean overall waiting time was 708 days. Comparing waiting time of male and female recipients in each of these groups did not show significant difference. In all categories of donors, females were less likely than males to be recipients. Furthermore, waiting time for females was longer than males when receiving kidney from sisters and children. For spousal donations, males were recipients more frequently than females although female recipients in this group waited less than their male counterparts to receive the kidney. Generally, our results are in accordance with results of similar researches. In all three mentioned groups, males com-prised the majority while the waiting time does not show significant difference between genders. We suggest some reasons for this phenomenon, of which the two main ones are: fewer females are suffering from ESRD and/or females have less chance to find a potential donor in the family, which can be attributed to their lower socio-economic status.

Background/Objective: Hepatitis E virus (HEV) has caused many acute hepatitis epidemics in developing countries. Considering the high prevalence of transaminitis on early stages after renal transplantation and the uncertainty of the hepatitis E's role, we evaluated serology of hepatitis E in this high risk group. Methods: 110 patients were evaluated. After kidney transplantation, anti-HEV IgG levels were measured by ELISA. BUN and creatinine levels after renal transplantation, AST, ALT, alkaline phosphatase, and estimated glomerular filtration rate (eGFR) in the first week, and the first, third, and sixth months after renal trans- plantation were measured. Results: HEV Ab of 23 patients was higher than 1.1; they were considered seropositive for HEV. Liver and renal function tests in different periods in patients with HEV Ab higher and lower than 1.1, showed no significant difference. In this study, there was no significant correlation between the levels of creatinine, AST, ALT, and alkaline phosphatase at various periods in patients with HEV Ab higher and lower than 1.1. In patients with HEV Ab <1.1, there were significant inverse relationships between HEV Ab and GFR in the first (p=0.047, r=-0.21), third (p=0.04, r=-0.20), and sixth (p=0.04, r=-0.22) months after renal transplantation. A significant direct correlation was observed between age and HEV Ab levels (p=0.001, r=0.33). Conclusion: Our findings showed a high prevalence of seropositivity of Anti HEV IgG in patients receiving renal transplants. However, liver and renal function test results were not significantly different between seropositive and seronegative recipients within 6 months of renal transplantations. [ABSTRACT FROM AUTHOR]

Background/Objective: In this study we compared the outcome of patients who underwent one of the two surgical methods of bladder augmentation, i.e., enterocystoplasty (EC) and ureterocystoplasty (UC) before kidney transplantation, with recipients of kidney who had normal bladder function. Methods: During a 26-year period (1988-2014), 2100 renal transplantations were performed in our center by a fixed team. In 22 patients (mean age 19.5 years) enterocystoplasty (group A) and in 12 patients (mean age 12.3 years) ureterocystoplasty (group B) were performed before renal transplantation. These two groups were compared with a control group of 34 recipients with a normal bladder (group C, mean age 17.6 years) for kidney function, graft and patient survival and episodes of urinary tract infection. Results: There was normal graft function in 15,10, and 31 patients in groups A, B, and C, respectively during a mean follow-up of 92, 73, and 82 months (p<0.8). The mean±SD serum creatinine in follow-up was 1.58±0.35, 1.42±0.15, and 1.31±0.51 mg/dL in groups A, B, and C, respectively. There were no statistically significant differences among the 3 groups in terms of 1, 5, and 10-year graft and patient survivals. Episodes of febrile UTI requiring hospital admission were 23, 7, and 2 in groups A, B, and C, respectively. UTI and urosepsis were significantly more frequent in group A than group B (p=0.035) and group C (p=0.001); however, there was no significant difference between groups B and C (p=0.330). Conclusion: Although augmentation cystoplasty with segment of intestine or dilated ureter is a safe and effective procedure for reconstruction of lower urinary tract before renal transplantation, in recipients with enterocystoplasty the frequency of febrile UTI and urosepsis is high; sometime it is dangerous. In long-term, there is no significant difference in graft function among the 3 groups. As a result augmentation cystoplasty (either method) is recommended before renal transplantation for reconstruction of lower urinary tract. [ABSTRACT FROM AUTHOR]

Background: Graft and patient survival are of great importance after transplantation. This study aimed to determine the long-term survival rate of kidney transplantation and its effective factors among transplanted patients in Mashhad transplantation centers in northeastern Iran., Methods: Overall, 618 kidney transplant recipients were examined in different transplantation centers during the years from 2000 to 2015 in a historical cohort study. The Kaplan-Meier method and the Log-rank test were used to calculate the survival rate of the kidney transplant, and to check the difference between survival curves respectively. Modeling of effective factors in survival rate was performed using Cox regression model., Results: Overall, 1, 3, 5, 7, 10, and 15-year survival rate of kidney transplantation were 99%, 98%, 97%, 93%, 88 and 70% respectively. The adjusted hazard ratio indicated that variables such as recipient age >40 yr [HR=0.22, 95% CI=(0.071,0.691)], serum creatinine after transplantation >1.6 Mg/dl [HR=3.03, 95% CI=(1.284,7.125)], history of hypertension [HR=6.70, 95% CI=(2.746,16.348)], and BMI [HR (normal weight versus underweight)=0.26, 95% CI=(0.088,0.761), HR (over weight versus underweight)=0.13,95% CI=(0.038,0.442)] were significant factors on kidney transplant survival rate., Conclusion: The short-term transplant survival rate was good in transplant patients. What's more, through a consideration of variables such as age, creatinine serum after transplantation, history hypertension and body mass index, as well as proper planning to control their effect, it is possible to improve the long-term graft survival rate., Competing Interests: Conflict of interest The authors state that there are no conflicts of interest., (Copyright © 2021 Alimi et al. Published by Tehran University of Medical Sciences.)

Background: The performance of a transplanted kidney is evaluated by monitoring variations in the value of the most important markers. These markers are measured longitudinally, and their variation is influenced by other factors. The simultaneous use of these markers increases the predictive power of the analytical model. This study aimed to determine the simultaneous longitudinal effect of serum creatinine and blood urea nitrogen (BUN) markers, and other risk factors on allograft survival after kidney transplantation., Methods: In a retrospective cohort study, the medical records of 731 renal transplant patients, dated July 2000 to December 2013, from various transplant centers in Mashhad (Iran) were examined. Univariate and multivariate joint models of longitudinal and survival data were used, and the results from both models were compared. The R package joineRML was used to implement joint models. P values <0.05 were considered statistically significant., Results: Results of the multivariate model showed that allograft rejection occurred more frequently in patients with elevated BUN levels (HR=1.68, 95% CI: 1.24-2.27). In contrast, despite a positive correlation between serum creatinine and allograft rejection (HR=1.49, 95% CI: 0.99-2.22), this relationship was not statistically significant., Conclusion: Results of the multivariate model showed that longitudinal measurements of BUN marker play a more important role in the investigation of the allograft rejection., (Copyright: © Iranian Journal of Medical Sciences.)

Background: Although IgG4 deposit against phospholipase A2 receptor (anti-PLA2R) is predominantly presented in the renal biopsy of patients with primary membranous nephropathy (MN), its diagnostic value of this immune complex has not been fully established., Methods: In this cohort study, 108 biopsy-proven MN patients with proteinuria were evaluated during two years follow up and were divided into primary and secondary groups. Renal biopsy specimens were pathologically assessed for IgG4 and PLA2R depositions by immunohistochemistry (IHC). Therefore, the relationships between staining severity, MN type and total proteinuria in all patients were determined., Results: Of 108 patients, 73.1% had primary MN and 26.9% were diagnosed as secondary form. IHC staining in patients with primary MN was positive for PLA2R in 76 (96.2%) and IgG4 in 68 (86.1%). Cases with positive PLA2R expression had a significantly higher rate among patients with mild to moderate stages (P = 0.03). No significant relationship was found between intensity of PLA2R and IgG4 deposits with proteinuria and serum creatinine. Based on our data, double positivity/negativity of PLA2R and IgG4 expression adds prominent information to the clinical data and were found to be useful and robust biomarkers for detection of primary MN patients with high sensitivity and specificity (97.1 and 96.3% respectively, PPV = 98.5% and NPV = 92.9%)., Conclusions: Simultaneously expression of PLA2R and IgG4 in renal biopsy specimens of patients with MN could possibly be used as a potential diagnostic method to distinguish primary from secondary MN and also pathological severity of the disease.

Background: The Area Under the Concentration-time curve (AUC) of Mycophenolic Acid (MPA), is a valid prognosticator of the risk of rejection and the gold standard in its Therapeutic Drug Monitoring (TDM), over time post-transplantation., Objective: This study aimed to investigate MPA pharmacokinetic parameters and develop a Limited Sampling Strategy (LSS) to estimate an abbreviated MPA AUC, in the stable phase post-renal transplantation., Methods: In this study, 19 patients with normal graft function (glomerular filtration rate >70 ml/min) who fulfilled the inclusion and exclusion criteria were involved. Blood samples at various times were taken in the stable phase after transplantation. MPA plasma concentration was measured by reverse-phase high-performance liquid chromatography. MPA AUC 0-12h was calculated using the linear trapezoidal rule. Multiple stepwise regression analysis was used to determine the minimal time points of MPA levels that could be used to yield model equations best fitted to MPA AUC 0-12h . The findings of this study were compared with the results of our previous study, which was done similarly in the early phase post-renal transplantation., Results: The results demonstrated that the MPA-AUC and clearance were not affected over time, but MPA-t max was significantly lower in the stable phase in comparison with the early phase (P=0.001). The best regression equation for AUC estimation in the stable phase was AUC=9.57*C 6 +27.238 (r 2 =0.907). The validation of the method was performed using the jackknife method. The mean prediction error of these models was not different from zero (P > 0.05) and had a high root mean square prediction error (7.91)., Conclusion: In conclusion, the pharmacokinetics of MPA could be affected by time after transplantation, making it essential to develop a limited sampling strategy as an efficacious approach for therapeutic drug monitoring during the stable post-transplant period., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Lophomonas blattarum is a flagellate protozoan which is known as an emerging parasite in the human respiratory system. Organ transplant recipients are considered as immunocompromised patients due to prescription of immunosuppressive drugs. This group of patients is susceptible to opportunistic infection as well as lophomoniasis. This study aims to investigate the prevalence and clinical manifestation of pulmonary infections caused by L. blattarum in kidney transplant recipients., Methods: This is a case-control study including 50 kidney transplant recipients and 50 controls. The sputum samples were collected from 50 kidney transplant recipients with bronchopulmonary infection signs suspected to lophomoniasis admitted in Montaserieh and Imam Reza hospitals, Mashhad, Iran. 50 healthy individuals as the control group were matched for sex and age with case ones. The consent form, checklist, and required information were provided for each patient. All samples were microscopically examined for the flagellated protozoan, L. blattarum , using direct smear., Results: Among 50 kidney transplant recipients suspected to lophomoniasis, L. blattarum was identified in sputum samples of 4 (8%) participants of the case group including one female and three males. None of the samples were positive among the control group. Symptoms in patients of this study were high fever (4 out of 4 patients), cough (3 out of 4 patients), and dyspnea (2 out of 4 patients). Three patients showed a positive response to metronidazole treatment., Conclusion: The results of this study suggest that L. blattarum should be considered as a pathogenic agent in kidney transplant recipients. It is necessary to examine sputum samples in posttransplant pneumonia patients, especially in those resistant to antibacterial therapy., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Zahra Gheisari et al.)

Background: In end-stage renal disease (ESRD) kidneys stop functioning effectively, and transplantation is considered as the best therapeutic intervention. Because of the increasing number of ESRD patients and the limited number of organ donors, identification of the right candidates for kidney transplantation on the waiting lists is of great importance., Aim: The purpose of the present study is to identify the factors affecting the prioritization of transplantation candidates based on the advice of a number of board-certified, local nephrologists., Materials and Methods: This cross-sectional study was conducted in 2017 based on the Standard for Reporting Qualitative Research (SRQR) protocol. In the first phase, 15 nephrology specialists were interviewed to collect their viewpoints, and results were analyzed based on the tagging framework. Then, a collection of the resulting factors were compiled into a checklist and validated using a Delphi method by 11 specialists. Eventually, final factors were selected using a weighting method followed by a practicality checking step. Weighting of factors was done by the analytic hierarchy process (AHP) technique and Expert Choice 11.0 was used to analyze the weightings., Results: After removing duplicates, 35 factors were extracted. Finally, using a Delphi study and the weighting method and a subsequent practicality checking step, 12 factors were identified. Age, body mass index, time on dialysis, history of kidney transplantation, and 8 other factors were among the final identified factors. The factor with the highest weight was simultaneous disease., Conclusion: Given the long waiting lists for kidney transplantation and the limited number of donated kidneys, selecting the candidate with highest priority is vital. Altogether, using these factors in the candidate identification process results in selecting the most suitable candidate for kidney transplantation; this may consequently increase the patient and graft survival rate.

Background: Acute lymphoblastic leukemia (ALL) is aggressive cancer, especially in adults as only 20-40% is cured with current treatment regimens., Objectives: The aim of this study is to evaluate prognostic factors and their effects on survival in ALL patients in the Northeast of Iran., Methods: In a descriptive and retrospective study from 2009 to 2015, 48 ALL patients referred to hematology-oncology clinic. Age, sex, fever, blood group, type of ALL and consumption of amphotericin B, forms of cytogenetic, survival in the patients, WBC, hemoglobin, and platelet were checked in the first referral for every patient. The mean follow-up was 27.3 months in which 28 patients (59.3%) died. overall survival (OS) was plotted by GraphPad Prism 5 and the Log-rank test was used for analysis of survival with risk factors., Results: The mean age for all the ALL patients at diagnosis was 32.3 years (range, 15-71 years), and 81.3% were male. Of all patients, 62.5% had fever and 25% consumed amphotericin B. 1-, 2-, 3-, 4-, 5-year OS rates were 62.2%, 52.7%, 40.6%, 39.1%, 22.2%, respectively. 75%, 29.2% and 39.6% of patients had WBC < 20 × 10 3 /μl, Hb < 7 g/dL and platelet < 30 × 10 3 /μL, respectively. There was a significant difference in survival based on age (P = 0.000)., Conclusions: Based on the results, age > 35 years is the most prognostic factor in ALL patients. Also, patients who received amphotericin B had lower life expectancy because these patients were suffering from fungal infection or due to lack of response to antibacterial drugs, they have been treated with amphotericin B., Competing Interests: Conflict of Interest:There is no conflict of interest.

Introduction: For diagnosing of specific types of bone lesions in hemodialysis (HD) patients, it is necessary to conduct a bone biopsy as the gold standard method. However, it is an invasive procedure. While different markers have been suggested as alternative methods, none of them has been selected. The frequency of hip fractures is 80 fold in HD patients who have two-fold mortality as compared with general population., Objectives: Recently, serum leptin has been suggested as a bone density marker. This study tries to confirm this proposal., Patients and Methods: In this study about 104 HD patients (53.8% male and 46.2% female) were enrolled. The average age was 38.28±7.89 years. Serum leptin, bone alkaline phosphatase, intact parathyroid hormone (iPTH), 25(OH)D, calcium, phosphorus and bone mineral density (BMD) (at the femoral neck and lumbar spine, as measured by dual-energy x-ray absorptiometry [DXA]) were assessed., Results: Analysis by polynomial regression revealed no correlation between BMD Z-score at two points and serum leptin level. According to the thresholds of 25 ng/mL and 18-24 ng/mL in some studies, we detected 25 ng/mL as the threshold in our patients. Under this threshold, the leptin effect on bone mass was negative, and above the threshold of 25 ng/mL, we found leptin had positive effect on bone mass., Conclusion: In this investigation, we found, leptin has a bimodal effect on bone mass. Cortical bones assessment may be a better option for assessment.

We studied plasma vitamin D level in 96 kidney transplant recipients and its circannual rhythm. Blood samples were tested for 25-hydroxy vitamin D, parathyroid hormone, creatinine, phosphate, and calcium levels in winter and summer 2014. The mean age was 41 years, and the mean transplant age was 6.1 years. Plasma levels of 25-hydroxy vitamin D were 18.0 ± 15.0 ng/mL in winter and 18.3 ± 14.7 ng/mL in summer (P = .64). Parathyroid hormone was inversely correlated with vitamin D level in both seasons (r = -0.044, P < .001). There was no relationship between vitamin D and other variables. Our study showed vitamin D deficiency is prevalent among kidney transplant recipients both in winter and summer. Also, vitamin D level did not rise from winter to summer. It is recommended to routinely check on kidney transplant recipients' vitamin D status.

Although hepatitis E virus (HEV) is well known to cause acute hepatitis, there are reports showing that HEV may also be responsible for progression of acute to chronic hepatitis and liver cirrhosis in patients receiving organ transplantation. In this study, we aimed to evaluate the prevalence of HEV in patients with kidney transplantation. In this study, 110 patients with kidney transplantation were recruited, and anti-HEV IgG, creatinine, alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and estimated glomerular filtration rate (eGFR) in the first, third and sixth months after renal transplantation were measured. The mean serum anti-HEV IgG titers in the study participants was 1.36 (range 0.23 to 6.3). Twenty-three patients were found to be seropositive for HEV Ab defined as anti-HEV IgG titer > 1.1. The difference in liver and renal function tests (creatinine, eGFR, AST, ALT and ALP) at different intervals was not significant between patients with HEV Ab titers higher and lower than 1.1 (p > 0.05). However, an inverse correlation was observed between HEV Ab and eGFR values in the first (p = 0.047, r = -0.21), third (p = 0.04, r = -0.20) and sixth (p = 0.04, r = -0.22) months after renal transplantation in patients with HEV Ab < 1.1 but not in the subgroup with HEV Ab > 1.1. Also, a significant correlation between age and HEV Ab levels was found in the entire study population (p = 0.001, r = 0.33). Our findings showed a high prevalence of seropositivity for anti-HEV IgG in patients receiving renal transplants. However, liver and renal functions were not found to be significantly different seropositive and seronegative patients by up to 6 months post-transplantation.

Introduction: Lupus nephritis is a serious organ involvement with unknown etiology, and glomerulonephritis class IV is one of the most severe forms of the disease which correlates with poor prognosis and death. Immunological abnormalities are implicated in the expression of lupus nephritis. In this study, we examined some T helper 17 and regulatory T-related cytokines and molecules in systemic lupus erythematosus patients with glomerulonephritis class IV., Materials and Methods: The study group comprised of 20 glomerulonephritis class IV SLE patients and 20 sex- and age-matched SLE patients without kidney involvement as control group. Blood samples was collected from each participant, lymphocytes were isolated, and RNA was extracted from lymphocytes. Then cDNA was synthesized using reverse transcription enzyme, and finally using specific primers and probes, the expression levels of forkhead box P3 (Foxp3), transforming growth factor (TGF)-β, interferon (IFN)-γ, interleukin (IL)-6, and IL-17 genes were analyzed by real-time polymerase chain reaction based on the TaqMan method., Results: The expression levels of IL-6, IL-17, IFN-γ, and Foxp3 genes were significantly higher in SLE patients with glomerulonephritis class IV than those with non-nephritis SLE. However, the expression of TGF-β was not significantly different between the SLE patients with and without glomerulonephritis class IV involvement., Conclusions: According to our results, it seems that in class IV glomerulonephritis patients, increased Foxp3-producing regulatory T cells has an imperfect capacity to control the pathogenic IL-17- and IFN-γ-producing cells.

Objectives: Iminoral is the generic microemulsion of cyclosporine. We performed a randomized double-blind multicenter trial to evaluate its efficacy and safety compared with the innovator medication Neoral for preventing acute rejection episodes in adult patients during the first year after renal transplant., Materials and Methods: We used 221 de novo renal transplant recipients from 6 transplant centers in Iran enrolled between April 2008, and January 2010. They were randomized to receive either Iminoral or Neoral as the calcineurin inhibitor component of the immunosuppressive regimen in addition to mycophenolate mofetil and oral corticosteroids. They were followed-up for 1 year. The primary endpoint was the rate of acute allograft rejection. Secondary endpoints consisted of 1-year graft survival rates, daily dosages of cyclosporine, trough and C2 cyclosporine blood level, serum creatinine levels, patient death rates, discontinuing the study drug, tolerability, and adverse events., Results: The risk of acute rejection episode during the first month after transplant was 9% for Iminoral and 10% for Neoral; these declined to 4% and 2% during next 11 months. One-year graft survival rate was 0.86 for both groups. Renal function stabilized during the first month. Declination of the creatinine levels was similar between the 2 groups and reached a stable value of 114.9 μmol/L five months after the transplant. The frequency of clinical complications was similar between the groups., Conclusions: Iminoral is safe and effective when used in de novo kidney transplant patients as an immunosuppressive medication.

Introduction: This study describes a new preperitoneal tunneling (PPT) method for inserting a peritoneal dialysis catheter (PDC), thereby lessening surgical complications and increasing the catheter's survival., Methods: This new technique was used in 23 cases from December 2005 to January 2007 and followed up until March 2011 (63 months). The procedure was performed laparoscopically under local (16 cases) or general (7 cases) anesthesia by one surgeon. Catheter survival is reported by Kaplan-Meyer analysis., Results: The catheters were mechanically obstructed in 2/23 cases (8.7%); and were withdrawn due to a peritonitis in 2 cases and inadequacy of peritoneal dialysis in 1 case. Ten patients received kidney transplantation and six died before completing this follow-up period. The patients still reaped the benefits of the PDC until receiving a kidney transplant or death. The 5-year survival rate of the catheter was 89%. No incidence of catheter migration, omental wrapping, herniation or leakage was noticed., Conclusion: Preperitoneal tunneling is a simple and safe method for insertion of PDC, and can effectively prevent catheter migration, dislocation and omental wrapping., (Copyright © 2014 International Society for Peritoneal Dialysis.)

Use of recombinant human erythropoietin (rh-Epo) improves hemoglobin (Hgb) in 90-95% of the cases of anemia of chronic kidney disease (CKD). However, it is known that pro-inflammatory cytokines such as interferon-gamma (IFN-γ), tumor necrosis factor-alfa (TNF-α) and interleukin-1 (IL-1) suppress erythropoiesis, resulting in inadequate response to rh-Epo. Pentoxifylline has been shown to have modulatory effects on the immune system. This prospective study to evaluate the effect of pentoxyphylline on erythropoeisis was performed on 15 (eight males, seven females) clinically stable patients who had been on hemodialysis for at least six months with anemia (Hgb of <10.7 g/dL) unresponsive to rh-Epo despite high doses. They were treated with 400 mg pentoxifylline tablets once daily for 12 weeks. Hgb increased after one and two months of drug administration, but significant changes were observed in eight (53%) patients after three months (P <0.05). Our study illustrates a probable new use for an old medicine. Three months treatment with pentoxifylline was seen to increase Hgb significantly in rh-Epo-resistant patients. More prospective studies with a larger sample size are needed to determine the inhibitory role of cytokines on hematopoiesis and exploring new drugs or new drug indications to overcome anemia in advanced renal failure.

This study was undertaken to assess the effect of simvastatin in the reduction of panel-reactive antibody (PRA) levels in patients with end-stage renal disease (ESRD) awaiting renal transplantation. During the 1-year period from September 2007 to August 2008, 60 ESRD patients with PRA levels more than 30% were enrolled into the study. Each patient was given oral simvastatin 10 mg/day as the initial dose. After one month, in those patients who did not respond, the dose was increased to 20 mg/day. Again, at the end of two months, if there was no response, the dose was further raised to 40 mg/day of simvastatin. The appropriate response to the treatment was defined as serum PRA levels getting reduced to less than 30%. Among the 60 patients who were enrolled in the study, three cases were excluded due to side-effects of the drug and 57 patients remained in our study. The mean age was 42.8 ± 28.2 years (range 18-75). Among these, 34 (59.6%) were females. Before the study, the PRA levels were between 30 and 100 (mean ± SD: 60.4% ± 20%). After the administration of simvastatin, a significant decrease in PRA levels was seen in our patients (P < 0.0001). In patients who had baseline PRA less than 40%, the PRA dropped to below 30% in 69.2% of the cases with 10 mg simvastatin. In those who had baseline PRA more than 40%, a similar reduction was seen only in 15.9% of the cases. However, in those who did not respond initially to 10 mg of simvastatin, statistically significant reductions were seen after the administration of 20 mg and, if needed, 40 mg of simvastatin (P = 0.001). In conclusion, simvastatin can be a useful drug in ESRD patients to lower the PRA levels.

Malignancy is a common complication after renal transplantation. However, limited data are available on post-transplant malignancy in living kidney transplantation. Therefore, we made a plan to evaluate the incidence and types of malignancies, association with the main risk factors and patient survival in a large population of living kidney transplantation. We conducted a large retrospective multicenter study on 12525 renal recipients, accounting for up to 59% of all kidney transplantation in Iran during 22 years follow up period. All information was collected from observation of individual notes or computerized records for transplant patients. Two hundred and sixty-six biopsy-proven malignancies were collected from 16 Transplant Centers in Iran; 26 different type of malignancy categorized in 5 groups were detected. The mean age of patients was 46.2±12.9 years, mean age at tumor diagnosis was 50.8±13.2 years and average time between transplantation and detection of malignancy was 50.0±48.4 months. Overall tumor incidence in recipients was 2%. Kaposis' sarcoma was the most common type of tumor. The overall mean survival time was 117.1 months (95% CI: 104.9-129.3). In multivariate analysis, the only independent risk factor associated with mortality was type of malignancy. This study revealed the lowest malignancy incidence in living unrelated kidney transplantation.

Aim: Cardiovascular (CV) disease is the leading cause of death in hemodialysis (HD) patients, and approximately half of mortalities in HD patients are attributed to CV disease. Atherosclerosis is the most frequent cause of CV complications in patients with end-stage renal disease (ESRD). Based on recent studies, cathepsin D has been suggested as a potential marker of atherosclerosis, and we hypothesized that there is an association between serum concentration of cathepsin D and carotid intima-media thickness (CIMT) in hemodialysis patients., Methods: Thirty-one hemodialysis patients (18 men and 13 women) were enrolled in this study. Serum levels of soluble cathepsin D were measured with an enzyme-linked immunosorbant assay (ELISA) kit. CIMT was determined in each patient., Results: The data showed that there was a positive significant correlation between serum concentration of cathepsin D and CIMT by using Pearson correlation (P value <0.05)., Conclusion: Based on the results of this study, cathepsin D could be suggested to have a role in the development of atherosclerotic plaques.

The human T lymphocyte virus-1 (HTLV-1) is the responsible pathogen for diseases such as HTLV-1 associated myelopathy (HAM) and adult T-cell leukemia (ATL). Mashhad, in northeast Iran, with high instances of this infection, has a noticeable number of infected renal failure patients. Since immunosuppressive drugs might decrease the latency period of HTLV-1 or increase its complications, the question arises whether HTLV-1 positive renal failure patients are suitable candidates for kidney transplants. To answer this, HTLV-1 positive recipients were evaluated in our study. Patients were divided into two groups. First group consisted of patients at the Imam Reza Hospital dialysis center. Second group had 20 kidney transplantation recipients consisting of ten infected and ten uninfected recipients as control from Imam Reza. Medical history of these patients was recorded and evaluated. The follow-up periods were between one and six years. Among them, 3.8% of patients undergoing dialysis were infected. The most important fact resulting from this study is that none of the infected recipients suffered from HAM or ATL during the follow-up period. In addition, it did not show any significant difference in the incidence of post-transplant complications between the infected and non-infected groups. Our study indicates that HTLV-1 positive patients may undergo kidney transplant without fear of increased incidence of side effects than those found in uninfected recipients. Because of short-term follow-up, probable long latency period of the virus, and the limited number of infected recipients, further work on this issue would be prudent.

Objective: It has been shown previously that the serum level of F2-isoprostanes acts as an indicator of oxidative stress, which is a risk factor for vascular disease especially in end-stage renal disease. It is not known whether n-3 polyunsaturated fatty acids can decrease oxidative stress in renal recipient patients., Design, Setting, and Subjects: In this single blind, randomized, placebo-controlled study, the effect of 3 and 6 months of fish oil administration on 8-isoprostane levels in renal transplant recipients was evaluated., Intervention: Twenty-two renal transplant patients who fulfilled inclusion and exclusion criteria randomly received either fish oil dietary supplementation, 6 g/day (720 mg of DHA and 1,080 mg of EPA) or placebo for 6 months., Main Outcome Measure: Serum 8-isoprostane concentration was measured as markers of oxidative stress., Results: A significant decrease in 8-isoprostane levels was observed only in the placebo group after transplantation compared to baseline (P < 0.05). However, the group receiving fish oil had a significantly lower cholesterol level than that of the placebo group (P < 0.05)., Conclusion: On the basis of our results, omega-3 fatty acids supplementation decreased the beneficial effects of kidney transplantation on oxidative stress., (Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

Chronic inflammation in dialysis patients increases the production of cytokines such as TNF-α, IL-1β and IFN- IFN-γ and there is evidence of a significant mortality rate in dialysis patients due to inflammation. Overproduction of inflammatory cytokines can induce complications such as atherosclerosis, malnutrition and anaemia, which are mostly resistant to erythropoietin treatment. Cardiovascular disease is the leading cause of death in haemodialysis patients and about half of the mortality is attributable to cardiovascular disease. Silymarin modulates the immune system by inhibition of neutrophil immigration, mast cell immobilization, prostaglandin production and leukotriene synthesis. Furthermore, silymarin suppresses the induction of TNF-α and it was hypothesized that silymarin could decrease the serum concentration of TNF-α in peritoneal dialysis patients, and thus treat anaemia. Fifteen peritoneal dialysis patients were enrolled in this study and serum levels of soluble TNF-α were measured using an enzyme-linked immunosorbant assay (ELISA) kit. Serum TNF-α was found to be decreased in some patients and in the response group, the haemoglobin concentration after 8 weeks of silymarin administration was increased significantly (p < 0.05). Based on the results of this study, it is suggested that silymarin may be useful in the treatment of inflammation for peritoneal dialysis patients., (Copyright © 2010 John Wiley & Sons, Ltd.)

Objectives: Mycophenolate mofetil, the prodrug of mycophenolic acid, is widely used for maintenance immunosuppressive therapy in renal transplant recipients. The effect of renal graft function on mycophenolic acid pharmacokinetics parameters is still controversial. The aim of this study is to investigate the impact of renal graft function on mycophenolic acid pharmacokinetics during the early posttransplant period., Materials and Methods: Our study was done on 13 patients with severe renal impairment (glomerular filtration rate < 30 mL/min, impaired group) and 13 patients with normal graft function (glomerular filtration rate < 70 mL/min, control group), at a steady mycophenolic acid plasma level, during the first month after transplant. All patients received a fixed dose of mycophenolate mofetil (1 g twice daily) in combination with cyclosporine and steroids. Mycophenolic acid plasma levels were determined by a validated high-performance liquid chromatography method. Mycophenolic acid area under the time concentration curve from 0 to 12 hours and apparent mycophenolic acid plasma clearance (CL/f) were measured for each patient., Results: Mycophenolic acid area under the time-concentration curve (0-12 h), mycophenolic acid area under the time-concentration curve (6-10 h), first peak concentration (Cmax1), and secondary peak concentration (Cmax2) were higher in the impaired group, while mycophenolic acid plasma clearance was higher in the control group (P < .05). Trough levels (C0) were similar for both groups (P < .05). There was a negative correlation between glomerular filtration rate and area under the time-concentration curve (r=-0.422, P = .04), while there was a positive correlation between glomerular filtration rate and mycophenolic acid plasma clearance (r=0.463, P = .02)., Conclusions: Mycophenolic acid pharmacokinetics parameters in normal renal function patients and severe renal impairment patients are different, and renal graft function correlates with total mycophenolic acid area under the time-concentration curve and apparent mycophenolic acid plasma clearance. However, the necessity of dosage adjustment based on renal graft function requires further studies.

Objectives: Mycophenolic acid, the active metabolite of mycophenolate mofetil, is administered with cyclosporine and oral steroids to prevent acute rejection after renal transplant. The aim of this study was to investigate correlations among time after transplant, subjects' demographics, and mycophenolate mofetil dosage according to body weight withmycophenolic acid pharmacokinetics during the early posttransplant period., Patients and Methods: Mycophenolic acid plasma levels of 19 patients were determined by a validated high-performance liquid chromatographic method at the steady state soon after transplant when graft function was good (glomerular filtration rate = 70 mL/min). All patients received a fixed dosage of mycophenolate mofetil (1 g b.i.d.) in combination with cyclosporine and steroids. The area under the time-concentration curve (AUC) and mycophenolic acid plasma clearance were measured for each patient., Results: The AUC from zero to 12 hours and trough levels increased as the time after transplant increased (P < .05), but mycophenolic acid plasma clearance decreased over time (P = .02). There was a correlation between total body weight and the AUC (P = .01, r2 = -0.627) as well as between total body weight and mycophenolic acid clearance (P = .04, r2 = 0.555). No statistically significant differences were found regarding mycophenolic acid plasma level, AUC, and mycophenolic acid plasma clearance with regard to sex or age of the subjects (P > .05). The mycophenolate mofetil dosage according to body weight correlated positively with the AUC (P = .01, r2 = 0.628), but there was a negative correlation between total body weight and mycophenolic acid plasma clearance (P = .02, r2 = -0.604)., Conclusions: Our results demonstrate that total body weight, time after transplant, and mycophenolate mofetil dosage according to body weight affect mycophenolic acid pharmacokinetics. We suggest that mycophenolic acid pharmacokinetics monitoring is necessary to individualize mycophenolate mofetil dosing during the early posttransplant period.

The population of elderly people with chronic renal insufficiency is increasing around the world. It has been shown that renal transplantation (RT) may be the best treatment for these patients. However, it has been observed that older patients who have received a RT have a higher mortality rate than those who are younger. The aim of this study was to evaluate the outcome of RT in recipients over 50 years of age. During the period between 1988 and 2002, 650 renal transplantations were performed at the Imam Reza Hospital in Mashad, Iran, of which 83 were performed in patients older than 50 years (50 to 66 years). We studied the one, three, and five-year patient and graft survival rates as well as the prevalence of urinary tract infection (UTI) after transplantation in these patients. We also evaluated the effect of the recipient's age and sex and the type of donor (related or unrelated) on patient survival as well as the prevalence of UTI. Patient survival at one, three, and five years after RT were 92.4%, 84.7%, and 75.6%, respectively. The graft survival at one, three, and five years after RT were 91.1%, 79.7%, and 66.7%, respectively. UTI occurred in 67.1% of patients after transplantation. The patient and graft survival rates were not related to the age and sex of the recipients and the type of donors. Also, there was no correlation between the prevalence of UTI and the age and sex of the recipients. Our study suggests that RT can be performed safely and with acceptable prognosis in elderly patients after appropriate clinical evaluation.

Background: Renal itch is a relatively common and distressing problem for patients with chronic renal failure. Granisetron, is a potent and selective inhibitor of 5-HT3 receptors. There have been some studies about the effect of ondansetron in uremic pruritus and one case report has recently described relief of renal itch with granisetron., Aims: To evaluate the effect of Granisetron on uremic pruritus in Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis (HD) patients., Methods: To study the prevalence of uremic pruritus, patients on CAPD and HD were asked to complete a pruritus questionnaire. Their replies were scored based on numerical scales. Pruritus was graded, according to the total points for each patient, as mild, moderate or severe. Fourteen patients with moderate to severe pruritus were enrolled in the trial. During treatment, patients received granisetron (1 mg tablet twice a day P.O), for a period of 1 month. They were asked to score the severity of pruritus twice a day., Results: Seventy seven percent of the patients responded to the treatment and at 1 st, 2 nd and 4 th week the mean values of the pruritus scores were 23, 16 and 8 points respectively. Before starting treatment the score was 31 points (P =0.03). Weekly clinical and laboratory examination showed no important side effects., Conclusion: Granisetron might be an effective, safe and well tolerated drug for the treatment of uremic pruritus.

Objectives: Owing to improvements in surgical techniques and clinical care, many of the earlier difficulties surrounding kidney transplants have been overcome and so, the number of operations performed has increased dramatically. Resource utilization and costs are now cited as problems for some transplant centers. Because length of hospitalization accounts for the largest portion of the total cost of the treatment process, we sought to determine and assess the factors that might reduce its length., Materials and Methods: We retrospectively studied the medical histories of 115 kidney transplant recipients and donors whose operations were performed between May 2000 and April 2002. Collected information for the recipients included sex, age, reason for kidney failure, weight, height, blood group, length of pretransplant dialysis, number of prior transplants (1 or 2), immunosuppressive regimen, postoperative complications (ie, lymphocele, wound infection, urinary tract infection, graft rejection), and hospitalization after the first discharge owing to postoperative complications. For donors, these demographics included age, sex, blood group, type of donor (deceased or living), and relationship to the recipient., Results: Length of pretransplant dialysis and relationship of the donor to the recipient were independently associated with predicting an increased length of hospitalization (and consequently, increased costs)., Conclusions: By reducing the length of pretransplant dialysis (wait time) and performing more operations between related donors and recipients, the length of hospitalization as well as the cost of treatment can be significantly reduced. Given the results of this study and owing to the increasing number of transplant surgeries occurring globally, future research should focus on analyzing other factors that affect length of hospitalization and associated costs.

Objectives: Previous studies of renal transplant recipients have suggested that weight gain after transplantation is relatively common. The purpose of this study was to define the occurrence, magnitude, and predictors of weight gain in this group., Material and Methods: We conducted a prospective study of 100 renal transplant recipients from 2002 to 2004 at Imam-Reza Hospital in Mashhad, Iran, to identify patterns of weight change attributed to sex, age at transplantation, socioeconomic class, and duration of dialysis. A descriptive study also was made on serum cholesterol and triglyceride levels in renal transplant recipients 12 months after transplantation. Patients' weights were evaluated at 3, 6, 9, and 12 months after transplantation., Results: Univariate analyses at 1 year posttransplantation showed that women had greater weight gains than did men (P = 0.003); older recipients had greater weight gains than did younger recipients (P = 0.009); weight gain was correlated with an increase in serum triglyceride and cholesterol levels (P = 0.000 and P = 0.004); and socioeconomic class was not correlated with weight changes (P = 0.955)., Conclusions: Female sex, older age, and increasing incidences of hypercholesterolemia and hypertriglyceridemia were significantly associated with weight gain 1 year after organ transplantation.