No abstract

Vitamin D insufficiency is common in patients suffering from end-stage renal disease (ESRD). In contrast, vitamin D supplementation could improve the status of ESRD patients (ESRDP). However, this effect's molecular mechanism is not fully understood. Therefore, this study aimed to assess vitamin D supplementation's impact on inflammation and oxidative signaling pathways in ESRDP. 104 ESRDP were divided into placebo (53) and vitamin D (51) groups. They were also categorized into four subgroups based on the severity of vitamin D deficiency. The dose of vitamin D3 (0.25-0.5mg/day) supplementation was determined based on plasma levels of calcium and parathyroid hormone (PTH). Vitamin D supplementation was performed for eight weeks. Serum levels of calcium, phosphorus, PTH, albumin, creatinine, ALP, and glomerular filtration along with antioxidant enzymes, malondialdehyde, and pro-inflammatory factors were measured. Moreover, the Nrf2 and NF-ĸB expression was evaluated in whole blood. According to the results, vitamin D supplementation improved the status of patients with ESRD significantly as compared with the placebo group (p<0.05). In addition, the expression of NF-ĸB and the serum levels of pro-inflammatory factors and malondialdehyde were significantly reduced. Finally, the expression of Nrf-2 and the serum of antioxidant enzymes were raised in the vitamin D group as compared with the placebo group (p<0.05). Vitamin D reduces clinical and metabolic symptoms in ESRDP by modulating gene expression (in oxidative stress and inflammation).

Background  Left ventricular hypertrophy (LVH) is an independent predictor for cardiovascular events in chronic kidney disease (CKD). Objectives  To find relationship between left ventricular hypertrophy and CKD stages during predialysis period and assess risk factors in CKD patients for left ventricular hypertrophy. Methods This cross-sectional study of 125 participant with CKD was conducted at Shar Teaching Hospital of Nephrology department, Sulaimani, Iraq. Left ventricular mass index (LVMI) was measured by using two-dimensional echocardiogram in the left decubitus position. LVH was labeled when the left ventricular mass index was >115 g/m² in men, and >95 g/m² in women on echocardiogram. We analyzed the baseline characteristic in 125 patients with chronic kidney diseaase. All patients underwent laboratory investigations which included serum creatinine, complete blood count, serum calcium, phosphate, intact parathyroid hormone, high density lipoprotein cholesterol HDL-C, low density lipoprotein LDL-C, triglyceride, and total cholesterol with urine albumin to creatinine ratio. Results  The mean age was 55.27± 14.51 years(male 60.0%, female 40.0%), and the prevalence of LVH was 68.0%, and it was increased with progressive decline in estimated glomerular filtration rate(eGFR) (P =0.005). independent risk factors for LVH were anemia (P =0.000), systolic and diastolic BP (P =0.000; P =0.001 respectively), intact PTH (P =0.038), body mass index BMI(P =0.045), serum calcium (P =0.003),serum phosphate (P =0.001) and majority of lipid profiles.  Conclusion There was a high prevalence of LVH in the CKD patients and it was increased with progressively decline in renal function. There was a significant association between systolic and diastolic BP, intact PTH, hemoglobin level, BMI, and minerals with LVH in CKD patients.

Background  Thalassemia major is one of the most inherited disorders in the Middle East; it has many complications related to iron overload and hepatitis viral transmission; complication of iron overload has destructing effect on many organ systems including liver; heart; pancreas; and lung. In the lung lead to pulmonary arterial hypertension which is defined as pulmonary artery systolic pressure ≥25mmHg during rest. Objectives  To detect the prevalence of pulmonary hypertension in patients with thalassemia major and how supportive measures affecting outcome of it. Patients and Methods A cross sectional study undertaken in Shaheid Hemn Teaching hospital, center for internal medicine diseases with collaboration of thalassemia center inside the hospital; 100 thalassemia major patients who are diagnosed previously by hemoglobin electrophoresis without any other comorbidity taken as a sample and echocardiography done using Phillips CX50 machine of 2009 model; the data then collected and using SPSS v23 for analyzing data. Results Study show 53% of thalassemia major has evidence of increased pulmonary artery pressure and only 1% has clinically significant pressure; splenectomy show high risk factor for occurrence of pulmonary hypertension but other supportive measures has no obstacle effect in its occurrence. Conclusion Most thalassemia major patients have evidence of pulmonary hypertension at least mild one; and putting splenectomy as a last line of managing them is recommended.

Background  Global increase in the incidence of end-stage renal disease has necessitated the performance of kidney transplantation for many patients. To minimize the possibility of renal allograft failure and maintain graft function. Kidney transplant recipients are typically given immunosuppressive drugs such as tacrolimus and Cyclosporine in combination with other drugs. Objectives  The present study was carried out to compare the effectiveness of tacrolimus versus Cyclosporine. Patients and Methods The present clinical non-randomized and non-controlled study was conducted on 201 kidney transplant patients in Shar teaching Hospital in Sulaimani, Kurdistan region-Iraq, from April 2020 to April 2021. The patients had received tacrolimus and Cyclosporine as immunosuppression drugs. Required data were collected from the patients through their hospital records and direct interviews with them. The collected data were analyzed through Statistical Package for Social Science (version 22.0). Results Most patients (60.7%) were aged 19-45 and males (70.6%). Most of them did not know the cause of chronic kidney failure (41.3%), focal segmental glomerulosclerosis in 14.4%, and diabetes mellitus in 12.4%. Most of the donors were non-related (90.5%). Induction treatment was anti-thymocyte globulin for most of them (76.6%), and treatment after transplant, mycophenolate mofetil, Cyclosporine and prednisolone in 75% of them. Acute cellular rejection was the most frequent complication after the transplant (23.4%). Tremor and new onset of diabetes were the most frequent side effects of tacrolimus; however, hirsutism, hyperkalemia, acne, hypertension, and hyperlipidemia are the most frequent side effects Cyclosporine. More patients on Tacrolimus than Cyclosporine developed new onset of diabetes (7.5%). However, serum uric acid (p<0.001), serum cholesterol (p<0.001), and serum triglyceride (p=0.01) levels elevate more with Cyclosporine group patients. Moreover, drug change has a significant association with haemoglobin level (HGB) (p<0.001) and serum triglyceride (p<0.001) in those group drug was changed to tacrolimus. Conclusion Similar rejection was obtained by using Tacrolimus and Cyclosporine within the first year after kidney transplant in low immunological risk patients; however, acute cellular rejection was less with the TAC group. It is less expensive than Cyclosporine in our region, but Cyclosporine is more available in the hospital.

Background  Several registries and centers have reported the result of renal biopsies from different parts of the world. Since there are no studies being conducted in Kurdistan region-Iraq, this raises the necessity of performing studies on renal biopsies to establish the pattern and trends of renal diseases Objectives  To identify the pattern of renal pathology among renal biopsy specimens. Materials and Methods A total of 2779 renal biopsies performed during 7 year period, between January 2010 and December 2016 in (Shorsh General Hospital) were retrospectively analyzed after exclusion of the reports with insufficient records and those from transplanted subjects. Results Among 1914 native biopsy cases 51.6% were males and 48.4% were females, the mean patient age was 31±17 years. The most frequent clinical presentations prior to renal biopsy were; proteinuria, renal impairment and hypertension. Majority of the biopsies showed some form of Glomerular diseases (81.5%) either Primary glomerular disease (63.17%) or Secondary glomerular disease (18.29%) followed by Miscellaneous and Tubulointersitial nephropathies. The most common Primary glomerular disease was Focal and segmental (41.7%) followed by Minimal change disease (23.8%), Membranous nephropathy (16.7%) and Immunoglobulin A nephropathy (6.1%). Among the Secondary glomerular disease, Hypertensive nephrosclerosis formed the commonest diagnosis (42.8%), followed by Lupus nephritis (34.6%), Amyloidosis (15.1%) and Diabetic nephropathy (7.4%).  Conclusion Primary glomerular disease was the most prevalent with Focal and segmental glomerulosclerosis and minimal change disease being the most frequent diagnosis. Among the Secondary glomerular disease Hypertensive nephrosclerosis was the commonest followed by Lupus nephritis.

Background  Renal transplant is the treatment of choice for patients with end-stage renal disease. To prevent graft rejection, recipients are receiving a combination of immunosuppressive medications. Among common side effects of the therapy, many oral manifestations are found either as a direct effect of the drugs or due to suppression of the immune system. Objectives  This study aimed to investigate oral problems and their relation to the oral hygiene status of the recipients. Patients and methods This cross-sectional study was performed on 150 renal transplant recipients in Sulaimani city, Kurdistan Region, Iraq, from December 2018 to June 2019. Any existing condition was diagnosed on a clinical basis. Additional data including a questionnaire of demographic, pharmacologic, and transplant duration were also collected.  Results The 150 transplant recipients included 103 males and 47 females (mean age 40.5 years). A total of 22.1% had at least one oral lesion. The most common lesion was gingival hyperplasia in 16.7% of cases who received cyclosporine A as the primary immunosuppressive medication, followed by candida infection 4.7%, which were mostly in patients with a transplant duration of less than 3 months. Conclusion In this study, we reported a lower incidence of oral lesions compared to other studies published in the literature. Improvement of oral hygiene status of the recipients is associated with reduced oral manifestation specifically gingival hyperplasia. Also, using prophylactic antifungal and antiviral agents during the first few months of transplant has a direct effect on reducing the number and frequency of viral and fungal infections.

No abstract