Tehran University Medical Journal

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Cyclosporine is one of the main immunosuppressors used for renal transplant recipients, and is given to prevent transplant rejection. Although the drug increases the survival of patients and grafted organs, it has some side effects independent of its effect on the immune system that are usually ignored. In this study, we evaluate the effect of cyclosporine on serum Mg levels and metabolic side effects in renal graft patients.
Methods: In this study, we followed 157 renal transplant recipients (62 females and 95 males) who were being treated with cyclosporine at a private clinic to prevent transplant rejection. The patients were first physically examined and then blood samples were obtained in order to measure levels of cyclosporine, Mg, creatinine, fasting blood sugar, lipids, calcium, phosphorus, and uric acid levels. We then analyzed the data for correlations between serum Mg levels, cyclosporine and other metabolic complications.
Results: The mean levels of Mg and cyclosporine were 196±0.31mg/dl and 371±192 μg/dl, respectively. Hypomagnesemia was detected in 16 patients (10.2%).There was a significant negative correlation (p<0.05) between levels of Mg and cyclosporine levels (r=-0.53), serum creatinine (r=-0.61), plasma LDL (r=-0.3), fasting blood sugar (r=-0.60) and uric acid (r=-0.36), and no correlation (p>0.05) between levels of Mg and calcium (r=0.2), phosphorus (r=-0.01), triglycerides (r=0.06) and HDL (r=-0.08). Mean levels of cyclosporine, creatinine, LDL, fasting blood sugar and uric acid in patients with hypomagnesemia were significantly different from those patients with normal serum Mg levels (p<0.05). There was no significant difference between the two groups with regard to mean total cholesterol, HDL, calcium and phosphorus (p>0.05).
Conclusion: According to the results of this and previous studies, there is a significant correlation between cyclosporine levels and hypomagnesemia as well as other biomedical complications secondary to hypomagnesemia. Therefore, we recommend routine serum Mg determination and greater attention to hypomagnesemic patients to prevent further complications.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Although the short-term results of kidney transplantation have improved greatly during the past decades, the long-term results have not improved according. Graft loss due to chronic allograft dysfunction (CAD) is a major concern in renal transplant recipients (RTRs). There is little data about disease progression in this patient population. In this paper, we investigated history of kidney function as the pattern, waiting time and rate of pass from intermediate stages in RTR with CAD.

Methods: In a single-center retrospective study, 214 RTRs with CAD investigated at the Urmia University Hospital urmia, Iran from 1997 to 2005. Kidney function at each visit assessed with GFR. We apply NKF and K/DOQI classification of chronic kidney disease (CKD) staging system to determine pattern of disease progression per stage in this group of patients.
Results: The pure death-censored graft loss was 26% with mean waiting time 81.7 months. 100% of RTRs passed from stage I to II in mean waiting time 26.3 months. The probability of prognostic factors transition from stage II to III was 88.9% with mean waiting time 25.5 months, transition from III to IV was 55.7% with mean waiting time of 24.9 months and transition for stage 4 to IV was 53.5% with mean waiting time of 18.2 months. In overall rate of transition from stage i to j in patients with stage III at the beginning of the study (time of start CAD's process) was faster than others.
Conclusions: This study revealed, that kidney function in first years after transplantation is one of the most important II to III of survival probability per stage and death-censored graft loss. Therefore care of RTRs in first year could potentially increase long-term kidney survival.

Background: Persistence of left ventricular hypertrophy (LVH) in renal transplant recipients is associated with unfavorable outcomes. Calcineurin-inhibitor (CNI) nephrotoxicity is a major cause of morbidity and mortality after kidney transplantation. In this study we compared sirolimus (SRL) with calcineurin-inhibitor as primary immunosuppressants for the attenuation of left ventricular hypertrophy in renal transplantation recipients.

Methods: In this prospective cohort study done in Shariati Hospital in 2010, we evaluated the effects of sirolimus and CNI on LVH of 55 renal transplant recipients. The cases (19) received sirolimus while the controls (36) received CNI while being matched for age and duration of transplantation. Data regarding blood pressure (BP), hemoglobin, serum creatinine, uric acid and lipid concentrations were assessed and changes in left ventricular (LV) mass were evaluated by echocardiography over a one-year follow-up.

Results: Left ventricular mass significantly decreased (P=0.0001) in the SRL group but blood pressure did not differ between the two groups. LV mass and LV mass index both decreased significantly (P≤0.05) but the difference was not associated with changes in BP. The difference in interventricular septal thickness at end diastole (IVSD) and posterior wall diameter (PWD) were significant (P≤0.05) in the SRL group but the difference in end diastolic diameter (EDD) was not significant.

Conclusion: Conversion from CNI to SRL-based immunosuppressive therapy in RTRs is safe and SRL may decrease LVH. SRL seems to be safe and improve renal function without cardiac compromise in kidney transplant recipients.

Background: Renal transplantation is the treatment of choice in patients with end-stage  renal disease. Urinary tract infection (UTI) is one of the most common complications after renal transplantation and it has serious consequences. The aim of this study was assessing UTIs in renal transplanted patients and evaluation of risk factors associated with post-transplant UTI.
Methods: In this prospective study, 173 patients (48 hospitalized patients and 125 outpatients) were enrolled in this study. These renal transplant recipients evaluated for bacterial urinary tract infection in urology research center at Sina Hospital. After collecting urine samples from symptomatic and asymptomatic patients, urinalysis and colony count were performed. Identification of bacteria was performed by routine microbiological tests in the Department of Pathobiology, School of Public Health, Tehran, Iran, in 2011.
Results: UTI was observed in 47 patients and the most prevalent microorganism was Escherichia coli (E.coli) 18(38.2%). Nearly 71% of UTI cases were diagnosed during the first three months post transplantation. Risk factors for post transplant UTI were female gender, age, length of hospitalization and diabetes mellitus. Female patients were more susceptible than males (OR=0.50 and P=0.047) to infection. There were no significant difference between diabetes mellitus and UTI. Most of the isolated bacteria were susceptible to imipenem and resistant to tetracycline and trimethoprim- sulfamethoxazole.
Conclusion: Our study confirmed that bacterial infections remain as the most common infectious complication in the early post-transplant period, and antibiogram rather than empirical treatment is needed to find the best effective antibiotics. Moreover, risk factors such as female gender, increased age and length of hospitalization are predisposing factors to increased urinary tract infection in renal transplantation.