Background: Chronic kidney disease is a persistent disorder in kidney function. This is a progressive disorder characterized by arterial hypertension, glomerular hypertension, proteinuria and some other signs; controlling any of them can reduce the progression of chronic kidney disease. In chronic kidney disease, proteinuria is used as a measure for monitoring nephron injuries and its response to treatment. Angiotensin converting enzyme inhibitors and Angiotensin receptor blockers can reduce the progression of chronic kidney disease by inhibition of Renin-Angiotensin-Aldosterone system and reduction of glomerular pressure and controlling proteinuria. However, none of them can control plasma aldosterone level appropriately. Aldosterone produces Transforming growth factor-b (TGF-b), which induces proliferation of fibroblasts and glomerulosclerosis and accelerates chronic kidney disease. Aldosterone antagonist can increase useful effects of angiotensin-converting-enzyme inhibitor (ACEI) and Angiotensin receptor blockers (ARB) Drugs. Objectives: The study was designed to assess the effects of spironolactone as the aldosterone antagonist combined with ACEI or ARB drugs to reduce proteinuria in chronic kidney disease to prevent its progression. Patients and Methods:This was a semi-experimental without control study. Eighty patients treated for at least two months with ACEI or ARB with uncontrolled proteinuria above 0.9g/dL were treated with 25mg/d spironolactone for two months. 24-hour urine protein and some other variables were measured at the beginning of the study, after two months treatment and one month after discontinuing the treatment. Results: Administration of 25 mg/d spironolactone combined with ACEI or ARB for two months led to mean reduction of 24 h-urine protein from 2796.1 to 1857.4. No hyperkalemia or change in glomerular filtration rate occurred. One month after discontinuation of spironolactone, proteinuria returned to baseline level. Persistence of reduction in proteinuria in patients receiving ARBs was more than those taking ACEIs. Conclusions: Spironolactone combined with ACEIs or ARBs leads to reduction of proteinuria in chronic kidney disease and therefore reduction of progression of the disease.
Introduction: One of the most important causes of erythropoietin-resistant anemia in end-stage renal disease (ESRD) patients is increased levels of inflammatory cytokines. Objectives: In this study pentoxifylline, an anti-inflammatory and anti-cytokine drug, with no significant side effects was used to manage anemia in ESRD patients. Patients and Methods: Thirty-nine ESRD patients with erythropoietin-resistant anemia were assigned to two groups, the treatment and the control groups. In treatment group, 19 patients received erythropoietin, venofer and pentoxifylline for 6 months. Patients in control group received erythropoietin and venofer. Hemoglobin (Hb), hematocrit (Hct), albumin and quantitative C-reactive protein (CRP) were measured at the beginning of the study, monthly and at the end of the study. Results: Hb and Hct were significantly increased in the treatment group (9.33±1.25 g/dL and 28.08±3.88% at baseline; 11.22 ± 1.26 g/dL and 34.02 ± 3.72% at sixth month, P = 0.01), but not in the control group. CRP was significantly decreased in the treatment group but no significant change occurred in the control group. Conclusion: Pentoxifylline is effective in improvement of erythropoietin-resistant anemia in ESRD patients.
Context:The colorectal cancer (CRC) is the most common malignancy between men and women. CRC has considerable morbidity and mortality, with more than 1000,000 new cases and 500,000 annual deaths. Regional lymph nodes are most common sites of metastasis from colon cancer. Lymph node involvement is an essential factor in enabling the accurate evaluation of prognosis in CRC patients.Aims:In this study, we focused on the frequency of CRC and involved lymph nodes and adequacy of lymph node dissection in patients who referred to the Oncology and Radiotherapy Department of Golestan Hospital in Ahvaz City located in South-West Iran.Setting and Design:We conducted a retrospective study among patients receiving surgical treatment for CRC in the Department of Oncology and Radiotherapy of Golestan Hospital in Ahvaz City located in South-West Iran between 2001 and 2010.Methods and Materials:All patients who underwent resection for CRC by open or laparoscopic approaches were included in the study. Data were collected from patients’ medical records.Statistical Analysis Used:Statistical data were analyzed using SPSS 21.Results:A total of 585 cases with CRC aged from16 to 89 years with mean age of 53-year-old were studied. Average number of dissected nodes was 8 lymph nodes, and lymph nodes were not found in pathology specimen of 61 cases (10.4%). In 199 patients (34.01%), number of dissected lymph nodes was 12 or more and in 386 patients (65.98%), number of dissected lymph nodes was <12.Conclusion:This study revealed a large amount of patients that had been under over treatment with radiotherapy and the following inability. Lack of removal of sufficient tissue by the surgeon during surgery or an inadequate sample check by a pathologist might lead to an inability to correct staging of the disease as well as the inability to determine the treatment program of the patients and over treatment with radiotherapy and chemotherapy.
Background: Atherosclerosis is the main cause of cardiovascular diseases, and its risk enhances in type 2 diabetes mellitus. Objectives: This study aimed to evaluate Carotid Intima-Media Thickness (CIMT) by carotid artery ultrasonography and assess its correlation with microalbuminuria and estimated Glomerular Filtration Rate (eGFR) in the patients with type 2 diabetes mellitus. Patients and Methods: This cross-sectional study was included 205 patients with Type 2 Diabetes Mellitus (T2DM). We recorded clinical and biochemical data such as FBS, lipid profile, and urinary albumin. Intima-media thickness of carotid arteries was measured in all patients by high frequency ultrasound. Results: In simple correlation coefficients analysis, CIMT was significantly associated with total cholesterol (r = 0.197, P = 0.008), serum creatinine (r = 0.240, P = 0.001), and urinary albumin (r = 0.420, P = 0.000). Also, CIMT elevated significantly with the stage progression of chronic kidney disease (0.67 ± 0.15 mm in stage 1, 0.73 ± 0.22 mm in stage 2, and 0.82 ± 0.21 mm in stage 3) (P value = 0.024). In multivariate linear regression analysis, the duration of diabetes, weight, HDL, serum creatinine, urinary albumin, and estimated Glomerular Filtration Rate (eGFR) were independently associated with CIMT (P value < 0.05 for all). Conclusions: Our study shows a relationship between CIMT and renal parameters, including eGFR and albuminuria. This study confirms the importance of intensive examinations for early detection of atherosclerosis and treatment of risk factors.
Background: Advanced glycation end-products (AGEs) cause proinflammatory responses and macromolecular damages. Advanced oxidation protein products (AOPPs) are protein biomarkers for oxidative stress. Levels of AGEs and AOPPs increase with the progression of chronic renal dysfunction. Objectives: In this study, we aimed to measure these species in patients with renal transplantation and to analyze their correlation with the measured glomerular filtration rate (GFR) and renal function parameters. Patients and Methods: Eighty renal transplant patients and normal subjects were recruited. GFR was measured by the two-sample plasma method with technetium-99m-labeled diethylenetriaminepentaacetic acid (TC99m-DTPA) clearance. Biochemical measurements included creatinine, cystatin C, urea, total protein, and pentosidine. Serum AGEs were determined using a fluorometric assay and AOPPs were estimated spectrophotometrically. Results: The measured GFR found to be significantly decreased in renal transplant patients compared to the control subjects (P< 0.001). Levels of AGEs, AOPPs, serum creatinine, and cystatin C were increased in renal transplant patients with lower values of measured GFR (mGFR). A significant association between the levels of AGEs species (serum fluorescence and pentosidine) and mGFR when adjusted for creatinine and other risk factors in multiple linear regression model analysis was found (P=0.05 and P=0.001, respectively). Conclusions: This study demonstrated increased levels of pentosidine and AGEs in transplant recipients were associated with decreased mGFR. Their accumulation can be predictive for the progression of chronic allograft loss of function.
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