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Elbeshbeshy H, Modi N, Patel T, Matthews I, Kampert T, Lee J, Okeke R, Caliskan Y, Fleetwood V, Varma C, Gabris B, Bastani B, Abu Al Rub F, Guenette A, Befeler A, Agbim U, Desai R, Alsabbagh E, Qureshi K, Schnitzler M, Lentine KL, Randall HB, Nazzal M. Outcomes of kidney, liver, and simultaneous liver and kidney transplants from hepatitis c infected donors to hepatitis c naïve recipients: A large single center experience. Clin Transplant 2024; 38:e15161. [PMID: 37842872 DOI: 10.1111/ctr.15161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/14/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND With the introduction of direct-acting antiviral therapies (DAAs), the non-use rate of hepatitis C virus (HCV)-positive donor organs (D+) has decreased significantly. We present the donor, recipient, and transplant allograft characteristics, along with recipient outcomes, in one of the largest cohorts of HCV-D+ transplants into HCV-naïve recipients (R-). METHODS Charts of HCV D+/R- kidney (KT), liver (LT), and simultaneous liver-kidney (SLKT) transplant recipients between January 2019 and July 2022 were reviewed. Primary outcomes of interest included waitlist times and 1-year graft failure. Secondary outcomes included hospital and intensive care unit length of stay, post-transplant complications, effectiveness of DAA therapy, and characteristics of patients who relapsed from initial DAA therapy. RESULTS Fifty-five HCV D+/R- transplants at our center [42 KT (26 nucleic acid testing positive [NAT+], 16 NAT-), 12 LT (eight NAT+, four NAT-), and one SLKT (NAT+)] had a median waitlist time of 69 days for KT, 87 days for LT, and 15 days for SLKT. There were no graft failures at 1 year. All viremic recipients were treated with a 12-week course of DAAs, of which 100% achieved end of treatment response (EOTR)-85.7% (n = 30) achieved sustained virologic response (SVR) and 14.3% relapsed (n = 5; four KT, one LT). All relapsed recipients were retreated and achieved SVR. The most common post-transplantation complications include BK virus infection (n = 9) for KT and non-allograft infections (n = 4) for LT. CONCLUSIONS Our study has demonstrated no graft failures or recipient deaths at 1 year, and despite a 14.3% relapse rate, we achieved 100% SVR. Complications rates of D+/R- appeared comparable to national D-/R- complication rates. Further studies comparing D+/R- to D-/R- outcomes are needed.
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Affiliation(s)
- Hany Elbeshbeshy
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Neal Modi
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Twinkle Patel
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Ian Matthews
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Timothy Kampert
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Jaenic Lee
- Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Raymond Okeke
- Department of Surgery, Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Yasar Caliskan
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Vidyaratna Fleetwood
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Chintalapati Varma
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Brittney Gabris
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Bahar Bastani
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Fadee Abu Al Rub
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Alexis Guenette
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Alex Befeler
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Uchenna Agbim
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Roshani Desai
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Eyad Alsabbagh
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Kamran Qureshi
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Mark Schnitzler
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Krista L Lentine
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Henry B Randall
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Mustafa Nazzal
- Center for Abdominal Transplantation, SSM Health Saint Louis University Hospital, St. Louis, Missouri, USA
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Nazzal M, Engelhardt A, Hallcox T, Van Gorp L, Parrish P, Okeke R, Kumanan K, Buchanan P, Schnitzler M, Rub FAA, Caliskan Y, Shacham E, Fleetwood V, Lentine KL, Jain A, Bastani B. The Effect of a Merit Point Incentive System on the Willingness to Donate Organs. Transplant Proc 2023; 55:2326-2332. [PMID: 37925234 DOI: 10.1016/j.transproceed.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/22/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Although over 90% of the population of the United States supports organ donation, only 60% of the population is registered as donors. Currently, there is a need for a nonmonetary incentive that will improve willingness to donate. We assessed the young adult population's perspective on their willingness to donate organs when merit points are granted to their family members to prioritize their potential transplant if needed. METHODS We administered a Qualtrics survey from March 2022 to September 2022 to the undergraduate students volunteering to participate at Saint Louis University, which comprised 10 questions that addressed the attitudes of participants regarding the effects of various factors, including the type of donation and the presence of merit points (vouchers granted to self or a family member to facilitate a potential transplant if needed), on participant's willingness to donate an organ while alive or after death. The responses were analyzed by using SAS software (SAS Institute). RESULTS A total of 572 participants completed the survey. Overall, only 6.5% of surveyed students were unwilling to donate after death. The willingness to donate while alive to a family member was significantly higher than donating to a stranger (95.8% vs 71.2%, P < .0001). When merit points were added, the unwillingness to donate significantly decreased from 6.5% to 3.8%. However, this change was observed only when the merit points were given to a family member and not to self. When merit points were granted, unwillingness to provide a living donation to a stranger decreased from 28.8% to 16.4% (P < .0001). CONCLUSIONS Merit points to first-degree family members improve students' expressed willingness to donate organs after death; however, self-merit points did not decrease the rate of "unwillingness to donate after death." When living donation is assessed, offering merit points appears to decrease the "unwillingness to donate to strangers." The adoption of a merit point system in the United States may increase the rates of organ donation.
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Affiliation(s)
- Mustafa Nazzal
- Center for Abdominal Transplantation, SSM-Saint Louis University Hospital, St. Louis, Missouri.
| | | | - Taylor Hallcox
- Saint Louis University School of Medicine, St. Louis, Missouri
| | - Luke Van Gorp
- Saint Louis University School of Medicine, St. Louis, Missouri
| | - Paul Parrish
- Saint Louis University School of Medicine, St. Louis, Missouri
| | - Raymond Okeke
- Department of Surgery, Saint Louis University Hospital, St. Louis, Missouri
| | | | - Paula Buchanan
- Saint Louis University School of Medicine, St. Louis, Missouri
| | - Mark Schnitzler
- Department of Surgery, Saint Louis University Hospital, St. Louis, Missouri
| | - Fadee Abu Al Rub
- Center for Abdominal Transplantation, SSM-Saint Louis University Hospital, St. Louis, Missouri
| | - Yasar Caliskan
- Center for Abdominal Transplantation, SSM-Saint Louis University Hospital, St. Louis, Missouri
| | - Enbal Shacham
- Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri
| | - Vidyaratna Fleetwood
- Center for Abdominal Transplantation, SSM-Saint Louis University Hospital, St. Louis, Missouri
| | - Krista L Lentine
- Center for Abdominal Transplantation, SSM-Saint Louis University Hospital, St. Louis, Missouri
| | - Ajay Jain
- SSM/Cardinal Glennon Children's Hospital, St. Louis, Missouri
| | - Bahar Bastani
- Center for Abdominal Transplantation, SSM-Saint Louis University Hospital, St. Louis, Missouri
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Ur Rehman A, Latif MH, Haider A, Mazhar E, Bastani B. A Rare Case of Nutcracker Phenomenon Associated With Midgut Malrotation and Congenital Solitary Kidney. Cureus 2023; 15:e49653. [PMID: 38161890 PMCID: PMC10756249 DOI: 10.7759/cureus.49653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
Medical conditions such as the nutcracker phenomenon, midgut malrotation, and congenital solitary kidney are rare. Hereby, we present a 21-year-old South Asian male referred to the nephrology clinic for hypertension and increased serum creatinine and was diagnosed with all three conditions. We briefly reviewed the literature on this subject. We present this case report to highlight the complex interplay of multiple renal and gastrointestinal anomalies and to emphasize the importance of a multidisciplinary approach in patient care to optimize outcomes and quality of life.
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Affiliation(s)
- Atta Ur Rehman
- Internal Medicine, Nishtar Medical University, Multan, PAK
| | | | - Ali Haider
- Internal Medicine, Nishtar Medical University, Multan, PAK
| | - Emaan Mazhar
- Internal Medicine, Nishtar Medical University, Multan, PAK
| | - Bahar Bastani
- Nephrology, Saint Louis University School of Medicine, St. Louis, USA
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4
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Hossain MF, Shah SS, Bastani B. An Adult Case of Severe Asymptomatic Bilateral Ureteropelvic Junction Obstruction. Case Rep Nephrol 2023; 2023:9355564. [PMID: 37736112 PMCID: PMC10511292 DOI: 10.1155/2023/9355564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/19/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023] Open
Abstract
While ureteropelvic junction (UPJ) obstruction is a well-recognized cause of unilateral or bilateral upper urinary tract dilatation in infants and the pediatric population, its occurrence in adults is less recognized. We present the case of a 68-year-old man who was being evaluated for chronic orthostatic hypotension and was incidentally found to have asymptomatic microscopic hematuria on urinalysis. A CT scan of the abdomen/pelvis, without and with contrast, revealed severe bilateral hydronephrosis due to UPJ obstruction. The patient has remained asymptomatic with preserved normal renal function over 7 years of follow-up.
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Affiliation(s)
- Md Fahad Hossain
- Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, St. Louis, USA
| | - Syed Sheheryar Shah
- Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, St. Louis, USA
| | - Bahar Bastani
- Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, St. Louis, USA
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Tamer MN, Brink DS, Bastani B, Miyata KN. Fibrillary glomerulonephritis diagnosed by an immunostaining for DNA-J heat-shock protein family member B9. Nephrology (Carlton) 2023; 28:255-256. [PMID: 36760027 DOI: 10.1111/nep.14148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Mehmet N Tamer
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - David S Brink
- Department of Pathology, Saint Louis University, St. Louis, Missouri, USA
| | - Bahar Bastani
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Kana N Miyata
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri, USA
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Taghrir MH, Akbarialiabad H, Abdollahi A, Ghahramani N, Bastani B, Paydar S, Razani B, Mwangi J, Asadi-Pooya AA, Roozbeh J, Malekmakan L, Kumar M. Inequity and disparities mar existing global research evidence on Long COVID. Glob Health Promot 2022; 30:63-67. [PMID: 35962520 PMCID: PMC10076956 DOI: 10.1177/17579759221113276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since the pandemic began in December 2019, SARS-Cov2 has accentuated the wide gap and disparities in socioeconomic and healthcare access at individual, community, country, and regional levels. More than two years into the current pandemic, up to three-fourths of the patients are reporting continued signs and symptoms beyond the acute phase of COVID-19, and Long COVID portends to be a major challenge in the future ahead. With a comprehensive overview of the literature, we found that most studies concerning long COVID came from high and upper-middle income countries, and people of low-income and lower-and-middle income regions and vulnerable groups with comorbid conditions have been neglected. Apart from the level of income, there is a significant geographical heterogeneity in investigating the Post-Acute Sequelae of COVID-19 (PASC) or what we call now, long COVID. We believe that these recognizing health disparities is crucial from equity perspective and is the first step toward global health promotion.
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Affiliation(s)
- Mohammad Hossein Taghrir
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Iran
| | - Hossein Akbarialiabad
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Iran
| | - Ashkan Abdollahi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Iran
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Penn State University College of Medicine, Hershey, USA
| | | | - Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Iran
| | - Babak Razani
- Cardiology Division, Department of Medicine, Washington University School of Medicine, St. Louis, USA.,Veterans Affairs St. Louis Healthcare System, John Cochran Division, St. Louis, USA.,Department of Pathology & Immunology, Washington University School of Medicine, St Louis, USA
| | - John Mwangi
- Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine, Saint Louis, USA
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Iran.,Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, USA
| | - Jamshid Roozbeh
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Iran
| | - Leila Malekmakan
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Iran
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Kenya.,Department of Clinical, Educational and Health Psychology, University College London, UK
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Seyrafian S, Sebghatollahi V, Bastani B. Hyponatremia‐induced generalized seizure after taking polyethylene glycol for colon preparation—A case report and brief review of the literature. Clin Case Rep 2022; 10:e6247. [PMID: 36052026 PMCID: PMC9413866 DOI: 10.1002/ccr3.6247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 07/21/2022] [Accepted: 08/01/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Shiva Seyrafian
- Isfahan Kidney Diseases Research Center Isfahan University of Medical Sciences Isfahan Iran
| | | | - Bahar Bastani
- School of Medicine Saint Louis University Saint Louis Missouri USA
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8
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Caliskan Y, Buck J, Lombardo L, Bastani B. Silica Urinary Stones: A Case Report and A Brief Review of Literature. Iran J Kidney Dis 2022; 16:266-268. [PMID: 35962642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/16/2022] [Indexed: 06/15/2023]
Abstract
Silicate stones are extraordinarily rare in human beings, but when present, they are often associated with ingestion of Magnesium Trisilicate, an antacid medication. However, there have been few case reports of patients who developed silicate stones, without ingestion of Magnesium Trisilicate. Hereby, we present the case of a 67-year-old man who developed acute kidney injury due to obstructive uropathy, detected during his scheduled chemotherapy for his relapsing multiple myeloma. Abdominal ultrasound and CT scan imaging demonstrated multiple non-mobile calcifications in the bladder neck/prostate bed. Stone analysis showed a material resembling silica. This case with silicate urinary tract stone highlights this extra-rare urinary stone in a patient without any identified source of silicate. DOI: 10.52547/ijkd.7044.
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Affiliation(s)
- Yasar Caliskan
- Division of Nephrology, Saint Louis University School of Medicine, Saint Louis, Missouri USA.
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9
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Akbarialiabad H, Taghrir MH, Abdollahi A, Ghahramani N, Kumar M, Paydar S, Razani B, Mwangi J, Asadi-Pooya AA, Malekmakan L, Bastani B. Long COVID, a comprehensive systematic scoping review. Infection 2021; 49:1163-1186. [PMID: 34319569 PMCID: PMC8317481 DOI: 10.1007/s15010-021-01666-x] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/10/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To find out what is known from literature about Long COVID until January 30, 2021. METHODS We undertook a four-step search with no language restriction. A preliminary search was made to identify the keywords. A search strategy of all electronic databases resulted in 66 eligible studies. A forward and backward search of the references and citations resulted in additional 54 publications. Non-English language articles were translated using Google Translate. We conducted our scoping review based on the PRISMA-ScR Checklist. RESULTS Of 120 papers, we found only one randomized clinical trial. Of the 67 original studies, 22 were cohort, and 28 were cross-sectional studies. Of the total 120 publications, 49.1% focused on signs and symptoms, 23.3% on management, and 10.8% on pathophysiology. Ten publications focused on imaging studies. The results are also presented extensively in a narrative synthesis in separated sections (nomenclature, diagnosis, pathophysiology, risk factors, signs/symptoms, management). CONCLUSIONS The controversies in its definition have impaired proper recognition and management. The predominant symptoms were: fatigue, breathlessness, arthralgia, sleep difficulties, and chest pain. Recent reports also point to the risk of long-term sequela with cutaneous, respiratory, cardiovascular, musculoskeletal, mental health, neurologic, and renal involvement in those who survive the acute phase of the illness.
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Affiliation(s)
- Hossein Akbarialiabad
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Taghrir
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ashkan Abdollahi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Penn State University College of Medicine, Hershey, PA, 17033, USA
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Razani
- Cardiology Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
- John Cochran Division, Veterans Affairs St. Louis Healthcare System, St. Louis, MO, 63106, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - John Mwangi
- Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Leila Malekmakan
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahar Bastani
- Professor of Medicine-Nephrology, Saint Louis University School of Medicine, Saint Louis, MO, USA.
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Fleetwood VA, Maher K, Satish S, Varma CR, Nazzal M, Randall H, Al-Adra DP, Caliskan Y, Bastani B, Rub FAA, Lentine KL. Clinician and patient attitudes toward use of organs from hepatitis C viremic donors and their impact on acceptance: A contemporary review. Clin Transplant 2021; 35:e14519. [PMID: 34672392 DOI: 10.1111/ctr.14519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/10/2021] [Accepted: 10/15/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The use of Hepatitis C (HCV) NAT positive allografts remains unusual and is clustered at few centers. We conducted a contemporary literature review to assess whether patient and clinician attitudes toward viremic organs impact acceptance. METHODS Databases including PubMed, MEDLINE, and SCOPUS databases were reviewed to identify studies focused on evaluating patient and provider perceptions of HCV NAT positive organ use within the DAA era (January 2015-April 2021). Search included MeSH terms related to Hepatitis C, transplantation, and patient and clinician attitudes. Two investigators extracted study characteristics including information on willingness to accept viremic organs, HCV-specific outcomes knowledge, HCV-specific concerns, and factors that contributed to acceptance or non-acceptance. RESULTS Eight studies met all inclusion criteria. These included three pretransplant patient-directed studies, two post-transplant patient-directed studies, one pre- and post-transplant patient-directed study, and two clinician-directed studies. Common themes identified were concerns regarding HCV cure rates, viremic organ quality, DAA cost, stigma, and the possibility of HCV transmission to household members. The perception of decreased waitlist time was associated with viremic organ acceptance. Physician trust played a mixed role in acceptance patterns. CONCLUSIONS Knowledge of high cure rates, shorter waitlist times, and higher organ quality appear to have the highest impact on organ acceptance.
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Affiliation(s)
- Vidya A Fleetwood
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Kennan Maher
- School of Public Health and Epidemiology, Saint Louis University, St Louis, Missouri, USA
| | - Sangeeta Satish
- School of Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - C Rathna Varma
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Mustafa Nazzal
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Henry Randall
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - David P Al-Adra
- Division of Transplant Surgery, Department of General Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Yasar Caliskan
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Bahar Bastani
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Fadee Abu Al Rub
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri, USA
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Akbarialiabad H, Rastegar A, Bastani B. How Sanctions Have Impacted Iranian Healthcare Sector: A Brief Review. Arch Iran Med 2021; 24:58-63. [PMID: 33588569 DOI: 10.34172/aim.2021.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/04/2020] [Indexed: 11/09/2022]
Abstract
Many studies have shown the crippling effects of sanctions on the healthcare sector of different countries, including Iran. Long-standing sanctions against Iran escalated recently and severely limited commercial activities with Iran. The devastating consequences of these embargoes have affected all aspects of health care delivery in Iran, limiting the availability of critical medicines and medical devices, and negatively impacting primary health care, treatment of complex diseases including cancer, medical tourism, and medical education and research. The present novel coronavirus disease 2019 (COVID-19) pandemic has uncovered this long-standing crisis in the Iranian health care sector. In this communication, we briefly discuss selected aspects of these sanctions and their impact on the health care system and people of Iran during this critical time.
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Affiliation(s)
- Hossein Akbarialiabad
- Student Research Committee, Shiraz University School of Medical Sciences, Shiraz, Iran
| | - Asghar Rastegar
- Professor of medicine-nephrology, Director, Global Health Program, Co-Director, Yale-Stanford J&J Global Health Scholar Program, Department of Medicine, Yale School of Medicine. New Haven, CT, USA
| | - Bahar Bastani
- Professor of Medicine-Nephrology, Saint Louis University School of Medicine, Saint Louis, MO, USA
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Akbarialiabad H, Bastani B, Taghrir MH, Paydar S, Ghahramani N, Kumar M. Threats to Global Mental Health From Unregulated Digital Phenotyping and Neuromarketing: Recommendations for COVID-19 Era and Beyond. Front Psychiatry 2021; 12:713987. [PMID: 34594251 PMCID: PMC8477163 DOI: 10.3389/fpsyt.2021.713987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
The new era of digitalized knowledge and information technology (IT) has improved efficiency in all medical fields, and digital health solutions are becoming the norm. There has also been an upsurge in utilizing digital solutions during the COVID-19 pandemic to address the unmet mental healthcare needs, especially for those unable to afford in-person office-based therapy sessions or those living in remote rural areas with limited access to mental healthcare providers. Despite these benefits, there are significant concerns regarding the widespread use of such technologies in the healthcare system. A few of those concerns are a potential breach in the patients' privacy, confidentiality, and the agency of patients being at risk of getting used for marketing or data harnessing purposes. Digital phenotyping aims to detect and categorize an individual's behavior, activities, interests, and psychological features to properly customize future communications or mental care for that individual. Neuromarketing seeks to investigate an individual's neuronal response(s) (cortical and subcortical autonomic) characteristics and uses this data to direct the person into purchasing merchandise of interest, or shaping individual's opinion in consumer, social or political decision making, etc. This commentary's primary concern is the intersection of these two concepts that would be an inevitable threat, more so, in the post-COVID era when disparities would be exaggerated globally. We also addressed the potential "dark web" applications in this intersection, worsening the crisis. We intend to raise attention toward this new threat, as the impacts might be more damming in low-income settings or/with vulnerable populations. Legal, health ethics, and government regulatory processes looking at broader impacts of digital marketing need to be in place.
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Affiliation(s)
- Hossein Akbarialiabad
- Research Center for Psychiatry and Behavioral Sciences, Department of Psychiatry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahar Bastani
- Medicine-Nephrology, Saint Louis University School of Medicine, Saint Louis, MO, United States
| | - Mohammad Hossein Taghrir
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Penn State University College of Medicine, Hershey, PA, United States
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya.,Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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Abstract
Immune checkpoint inhibitors (ICIs) are novel humanized monoclonal antibodies that release the brakes on the immune system, resulting in the destruction of tumor cells. ICIs are approved for a variety of hematological and solid organ malignancies, and the list has been growing since the approval of ipilimumab in 2011. ICIs are associated with a variety of immune-related adverse events (irAEs). irAEs commonly affect the skin, the gastrointestinal (GI) tract, and the endocrine system. Acute kidney injury (AKI) due to ICIs (ICI-AKI) occurs in a minority of patients, and it is usually due to acute tubulointerstitial nephritis (ATIN). Treatment with corticosteroids is usually successful. There have been reports of electrolyte disorders due to ICIs, including hyponatremia, hypocalcemia, hypokalemia, and Fanconi syndrome. The diagnosis of electrolyte disorders requires vigilance and routine laboratory monitoring.
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Affiliation(s)
| | - Bahar Bastani
- Internal Medicine - Nephrology, Saint Louis University School of Medicine, Saint Louis, USA
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14
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Akbarialiabad H, Kavousi S, Ghahramani A, Bastani B, Ghahramani N. COVID-19 and maintenance hemodialysis: a systematic scoping review of practice guidelines. BMC Nephrol 2020; 21:470. [PMID: 33172405 PMCID: PMC7653213 DOI: 10.1186/s12882-020-02143-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/30/2020] [Indexed: 12/23/2022] Open
Abstract
Background Coronavirus Disease 2019 (COVID-19) has substantially impacted the provision of medical services. During the pandemic, many medical services, including facilities providing care to patients with end stage renal disease faced challenges in safeguarding patients and staff while providing clinical care. This study aims to identify the extent, range, and nature of articles related to COVID-19 and maintenance hemodialysis to understand the research gaps and propose recommendations for future research. Methods Using the terms: “Dialysis” OR “RRT” OR “Renal replacement therapy” AND “SARS-COV-2” OR “COVID-19” OR “novel coronavirus” OR “2019-nCov”, we performed a multi-step systematic search of the literature in the English language in Pubmed, Scopus, Embase, and Web of Science published from December 1, 2019, to May 13, 2020. Two authors separately screened the title and abstracts of the documents and ruled out irrelevant articles. We obtained a full report of the papers that met our inclusion criteria and screened the full texts. We conducted a descriptive analysis of the characteristics of the included articles and performed a narrative synthesis of the results. We conducted this scoping review in accordance with the PRISMA-ScR Checklist. Results We included 22 articles in this scoping review. Perspectives (n = 9), editorials (n = 4), and case series (n = 5) were the most common types of articles. Most articles were from Italy and the United States. Seventeen (77.3%) of the articles focused on the topic of recommendation for outpatient hemodialysis units. While many of the recommendations overlapped in several articles, there were also many unique recommendations. Conclusions most of the articles are based on single-center experience, which spontaneously developed best practices. Many of these practices have formed the basis for policies and guidelines that will guide future prevention of infection and management of patients with End Stage Renal Disease (ESRD) and COVID-19.
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Affiliation(s)
- Hossein Akbarialiabad
- Shiraz University of Medical Sciences, Shiraz Medical School, Zand Street, Shiraz, 7134845794, Iran
| | - Shahin Kavousi
- Shiraz University of Medical Sciences, Shiraz Medical School, Zand Street, Shiraz, 7134845794, Iran
| | - Aria Ghahramani
- Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | - Bahar Bastani
- Medicine-Nephrology, Saint Louis University School of Medicine, 3635 Vista Ave, St Louis, MO, 63110, USA
| | - Nasrollah Ghahramani
- Medicine and Public Health Sciences, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.
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15
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Akbarialiabad H, Dalfardi B, Bastani B. The Double-Edged Sword of the Dark Web: Its Implications for Medicine and Society. J Gen Intern Med 2020; 35:3346-3347. [PMID: 32424783 PMCID: PMC7661673 DOI: 10.1007/s11606-020-05911-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Hossein Akbarialiabad
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behnam Dalfardi
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahar Bastani
- Division of Nephrology-Department of Medicine, School of Medicine, Saint Louis University, Saint Louis, MO, USA.
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16
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Abstract
Severe dysnatremias are perplexing problems in patients undergoing renal replacement therapy on a chronic or acute basis. The ability to manipulate sodium concentration in the dialysate or replacement solutions is limited. Compounding dialysate or replacement fluids to alter sodium concentration could result in errors. Rapid correction of hyponatremia or hypernatremia due to equilibrium with dialysate or replacement solutions could lead to osmotic demyelination syndrome or cerebral edema respectively. Continuous renal replacement therapy is the preferred dialysis modality in patients with severe dysnatremias. In this article, we present simple formulas to determine the rate of hypotonic or hypertonic solutions needed to mitigate rapid correction of dysnatremias. These formulas can be used readily by the clinician at bedside.
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Affiliation(s)
| | - Bahar Bastani
- Division of Nephrology, Saint Louis University Health Sciences Center, St. Louis, MO, USA
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17
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Tayebi Khosroshahi H, Bastani B. Some Interesting Stories From The Iranian Model of Kidney Transplantation. Urol J 2020; 17:422-425. [PMID: 31587250 DOI: 10.22037/uj.v0i0.5440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/08/2019] [Indexed: 11/18/2022]
Abstract
In this short communication we briefly discuss some aspects of organ shortage for transplantation with a brief characterization of the Iranian model of kidney transplantation, and we present 3 interesting stories related to this model.
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Affiliation(s)
| | - Bahar Bastani
- Division of Nephrology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA.
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18
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Caliskan Y, Caza T, Mosman A, Elawa U, Philipneri M, Martin K, Bastani B. A case of immune complex mediated tubulointerstitial disease and nephrotic syndrome: anti LRP-2 Nephropathy with diffuse podocyte effacement. J Nephrol 2020; 34:915-919. [PMID: 32472527 DOI: 10.1007/s40620-020-00762-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/23/2020] [Indexed: 11/25/2022]
Abstract
Anti-LDL Receptor-Related Protein 2 (Anti-LRP2) nephropathy is a rare form of kidney disease that affects the older patients and is characterized with acute kidney injury (AKI) and progressive renal tubular injury associated with IgG immune complex deposits along the basement membrane of proximal tubules, and circulating autoantibodies to the proximal tubule brush border protein LRP2 (megalin). We present the case of a 79-year-old man who was hospitalized for worsening malaise, abdominal distention and bilateral lower extremity edema, diagnosed with AKI and had nephrotic range proteinuria. Percutaneous kidney biopsy revealed tubulointerstitial nephritis with IgG immune complex deposits along the basement membrane of proximal tubules and brush borders. Immunofluorescence staining for LRP2 (megalin) showed similar granular tubular basement membrane deposits along the proximal tubules and proximal tubule brush borders. Electron microscopy revealed global podocyte foot process effacement. The patient was started on oral prednisolone 1 mg/kg and rituximab at a dose of 375 mg/m2 once weekly for 4 weeks with gradual tapering of prednisone. This case with AKI and nephrotic syndrome highlights the significant morphologic overlap with minimal change disease and anti-LRP2 nephropathy, which is associated with autoantibodies to the tubular brush border protein LRP2/megalin.
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Affiliation(s)
- Yasar Caliskan
- Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, Floor 9, Desloge Towers, 3635 Vista Ave., St. Louis, MO, 63110, USA.
| | | | - Amy Mosman
- Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, Floor 9, Desloge Towers, 3635 Vista Ave., St. Louis, MO, 63110, USA
| | - Usama Elawa
- Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, Floor 9, Desloge Towers, 3635 Vista Ave., St. Louis, MO, 63110, USA
| | - Marie Philipneri
- Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, Floor 9, Desloge Towers, 3635 Vista Ave., St. Louis, MO, 63110, USA
| | - Kevin Martin
- Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, Floor 9, Desloge Towers, 3635 Vista Ave., St. Louis, MO, 63110, USA
| | - Bahar Bastani
- Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, Floor 9, Desloge Towers, 3635 Vista Ave., St. Louis, MO, 63110, USA
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Gourtzelis N, Margassery S, Bastani B. Successful Treatment of Severe Mycobacterium fortuitum Exit-Site Infection with Preservation of the Tenckhoff Catheter. Perit Dial Int 2020. [DOI: 10.1177/089686080502500622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- N. Gourtzelis
- Nephrology Internal Medicine St. Louis University St. Louis, Missouri, USA
| | - S. Margassery
- Nephrology Internal Medicine St. Louis University St. Louis, Missouri, USA
| | - B. Bastani
- Nephrology Internal Medicine St. Louis University St. Louis, Missouri, USA
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Bastani B, Spyker DA, Westervelt FB. Peritoneal Absorption of Vancomycin during and after Resolution of Peritonitis in Continuous Ambulatory Peritoneal Dialysis (CAPO) Patients. Perit Dial Int 2020. [DOI: 10.1177/089686088800800205] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We studied the absorption of i.p. loading dose of vancomycin (30 mg/kg of body weight) in five continuous ambulatory peritoneal dialysis (CAPD) patients, both at the time of peritonitis and after its resolution. Mean vancomycin absorption after 6 h of i.p. dwell was 74% from inflamed and 51% from noninflamed peritoneum. Mean peritoneal absorption half-life of vancomycin was 3.2 and 7.2 h in the inflamed vs. non inflamed peritoneum, respectively.
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Affiliation(s)
- B. Bastani
- Divisions of Nephrology and Clinical Pharmacology, Department of Medicine, University of Virginia Hospitals, Charlottesville, Virginia
| | - D. A. Spyker
- Divisions of Nephrology and Clinical Pharmacology, Department of Medicine, University of Virginia Hospitals, Charlottesville, Virginia
| | - F. B. Westervelt
- Divisions of Nephrology and Clinical Pharmacology, Department of Medicine, University of Virginia Hospitals, Charlottesville, Virginia
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Bastani B, Islam S, Boroujerdi N. Iron Absorption after Single Pharmacological Oral Iron Loading Test in Patients on Chronic Peritoneal Dialysis and in Healthy Volunteers. Perit Dial Int 2020. [DOI: 10.1177/089686080002000614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Oral iron is poorly absorbed in chronic dialysis patients. We tested the hypothesis that a superpharmacologic dose of iron sulfate (260 mg elemental iron) administered on an empty stomach results in significant iron absorption in these patients. Design A prospective open controlled trial. Setting Outpatient department of a university hospital. Patients Nine stable chronic peritoneal dialysis (PD) patients and seven normal control subjects. Method All subjects ingested a single dose of 4 tablets of iron sulfate (260 mg elemental iron total) in the morning while fasting. Outcome Measures Serum iron concentrations at baseline, and at 2 and 4 hours after the oral dose were compared between the two groups. Results The control group showed a significant rise in mean [± standard error (SE)] serum iron concentration, from a baseline value of 76.5 ± 7 μg/dL to 191 ± 10.5 μg/dL at 2 hours and to 190 ± 24 μg/dL at 4 hours. This result represents a percentage rise of 164% ± 32% at 2 hours and 152% ± 28.5% at 4 hours. In the PD patients, a significant rise in serum iron concentration was also seen, from a baseline value of 64 ± 8 μg/dL to 130 ± 3 μg/dL at 2 hours and 111 ± 18 μg/dL at 4 hours. This result represents a percentage rise of 105% ± 29% at 2 hours and 77% ± 23.5% at 4 hours. However, the absolute change in serum iron concentration in PD patients at 2 and 4 hours was approximately equal to 50% of the change in control subjects at those time points. None of the PD patients experienced gastrointestinal side effects; 4 control subjects experienced mild side effects. Conclusion Despite impaired oral iron absorption in chronic dialysis patients, a large pharmacologic dose given orally can result in significant iron absorption and may prove to be a more efficient means of oral iron supplementation therapy in these patients.
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Affiliation(s)
- Bahar Bastani
- Division of Nephrology, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Shah Islam
- Division of Nephrology, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Nasser Boroujerdi
- Whittier Dialysis Center–Friendly Hills Medical Center, Whittier, California, U.S.A
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22
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Affiliation(s)
- B. Bastani
- Department of Internal Medicine Division of Nephrology Saint Louis University St. Louis, Missouri, U.S.A
| | - S. Gulley
- Department of Internal Medicine Division of Nephrology Saint Louis University St. Louis, Missouri, U.S.A
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23
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Bastani B, Sherman RA, Freer K, Davis M, Read D, Engels D, Bailey S, Westervelt FB. Further Experience with Two Intraperitoneal Vancomycin Loading Doses for Treatment of Gram-positive or Sterile Peritonitis in CAPD Patients. Perit Dial Int 2020. [DOI: 10.1177/089686088800800108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present a new protocol for treatment of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. In this protocol, episodes of gram-positive or “sterile” peritonitis are treated with two intraperitoneal (i.p.) doses of vancomycin (30 mg{kg with 6 h of i.p. dwell) which are given one week apart. Patients whose initial peritoneal fluid Gram stain does not reveal any organisms receive an intramuscular (i.m.) loading dose of tobramycin or gentamycin in addition, until the culture result becomes available at 48 h. Those with a negative peritoneal fluid culture (“sterile” peritonitis) receive maintenance i.p. gentamycine or tobramycin. We report our experience with 24 episodes of gram-positive or “sterile” peritonitis. Except for 1 of the 24 episodes that was followed with two successive relapses, all the other episodes responded well (cure rate of 96%). In only 15% of the instances patients were hospitalized to be assisted with their CAPD exchanges. We conclude this new approach remarkably simplifies treatment of peritonitis in CAPD patients, and based on our preliminary results it seems to be as effective, if not superior to, the currently employed treatment protocols. Further studies with this therapeutic regime with careful audiometric evaluation of those who receive both vancomycin and aminoglycoside are necessary in future.
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Affiliation(s)
- Bahar Bastani
- Renal Division, Department of Internal Medicine, University of Virginia Medical Center, Charlottesville, Virginia
| | - Ruth Ann Sherman
- Renal Division, Department of Internal Medicine, University of Virginia Medical Center, Charlottesville, Virginia
| | - Kathryn Freer
- Renal Division, Department of Internal Medicine, University of Virginia Medical Center, Charlottesville, Virginia
| | - Marlean Davis
- Renal Division, Department of Internal Medicine, University of Virginia Medical Center, Charlottesville, Virginia
| | - Deborah Read
- Renal Division, Department of Internal Medicine, University of Virginia Medical Center, Charlottesville, Virginia
| | - Darial Engels
- Renal Division, Department of Internal Medicine, University of Virginia Medical Center, Charlottesville, Virginia
| | - Sandy Bailey
- Renal Division, Department of Internal Medicine, University of Virginia Medical Center, Charlottesville, Virginia
| | - Frederic B. Westervelt
- Renal Division, Department of Internal Medicine, University of Virginia Medical Center, Charlottesville, Virginia
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24
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Amin K, Bastani B. Intraperitoneal Ondansetron Hydrochloride for Intractable Nausea and Vomiting Due to Diabetic Gastroparesis in a Patient on Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080202200421] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- K. Amin
- Division of Nephrology Department of Internal Medicine Saint Louis University School of Medicine 3635 Vista Avenue, FDT-9N St. Louis, Missouri 63110 USA
| | - B. Bastani
- Division of Nephrology Department of Internal Medicine Saint Louis University School of Medicine 3635 Vista Avenue, FDT-9N St. Louis, Missouri 63110 USA
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25
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Affiliation(s)
- B. Bastani
- University of Virginia School of Medicine Charlottesville, VA 22908
| | - F.B. Westervelt
- University of Virginia School of Medicine Charlottesville, VA 22908
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26
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Tinawi M, Bastani B. A case of Fanconi syndrome as a complication of treatment with a checkpoint inhibitor in a patient with hepatocellular carcinoma. J Nephropathol 2019. [DOI: 10.34172/jnp.2020.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Immune checkpoint inhibitors (CPIs) represent novel new cancer immunotherapy agents. The use of nivolumab has been linked with immune mediated acute interstitial nephritis (AIN). Case Presentation: We present the case of a patients with recurrent hepatocellular carcinoma who developed severe Fanconi syndrome, as evidenced by hyperchloremic metabolic acidosis, hypokalemia, hypophosphatemia, glucosuria, aminoaciduria, 8 months after initiating treatment with nivolumab, without any evidence of acute renal insufficiency. Conclusion: Clinicians need to be aware of the renal side effects of new novel cancer immunotherapy agents, such as, immune CPIs
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Affiliation(s)
- Mohammad Tinawi
- Nephrology Specialists, P.C. 801 MacArthur Blvd., Ste. 400A, Munster, IN 46321, USA
| | - Bahar Bastani
- Division of Nephrology, Saint Louis University Health Sciences Center, 3635 Vista Ave, St. Louis, MO, USA
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Abstract
Transplantation remains the modality of choice for patients with end stage renal disease (ESRD). However, while there has been a steady rise in the number of patients with ESRD the supply of donors (combine living and deceased) has fallen far behind the need, resulting in an increasing number of qualified patients remaining on the wait-list, and thousands being removed from the list every year because of death or becoming too sick for transplantation. This has also fed to transplant tourism around the world. Several countries have implemented a variety of policies to overcome their organ shortage that are presented in this article. There is an urgent need for developing policies geared to the cultural norms of different societies and universally accepted ethical principles to remedy this public health issue.
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Affiliation(s)
- Bahar Bastani
- Division of Nephrology, Saint Louis University Hospital, Saint Louis University School of Medicine, 3635 Vista Avenue, Saint Louis, MO, 63110, USA.
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28
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Sunna RR, Sodhi R, Purvis FA, Ouseph R, Brink DS, Bastani B. A case of severe nephrotic syndrome caused by isolated CMV glomerulopathy with ganciclovir resistant UL 97 mutation. J Nephropathol 2019. [DOI: 10.15171/jnp.2019.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: While many cases of cytomegalovirus (CMV) nephropathy have been reported in the literature, isolated CMV glomerulopathy is considered a rare finding. Case Presentation: We report the case of a CMV-negative recipient of kidney allograft from a CMVpositive donor (D+/R-), the recipient subsequently developed severe nephrotic syndrome secondary to biopsy-proven isolated CMV glomerulopathy. Conclusion: The patient developed CMV viremia with ganciclovir resistant UL97 mutation. His treatment course was resistant to recommended dose of intravenous ganciclovir, so therapy was changed to foscarnet with resolution of his viremia and reduction in proteinuria.
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Affiliation(s)
- Ramez R. Sunna
- Department of Internal Medicine, Division of Nephrology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Rupinder Sodhi
- Department of Internal Medicine, Division of Nephrology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Francis Arden Purvis
- Transplant Institute, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Rosemary Ouseph
- Department of Internal Medicine, Division of Nephrology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - David S. Brink
- Department of Pathology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Bahar Bastani
- Department of Internal Medicine, Division of Nephrology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
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29
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Bastani B. Hyperuricemia; the renewed interest in an old enemy. J Renal Inj Prev 2019. [DOI: 10.15171/jrip.2019.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Bahar Bastani
- School of Medicine, Saint Louis University, Saint Louis, Missouri 63110, USA
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Abstract
Background: Calciphylaxis is a potentially fatal condition previously observed in patients with poor renal function. We present a case of atypical presentation in a patient with good renal function after transplantation. Case Presentation: A-68-year old African American female with history of end-stage renal disease (ESRD) secondary to type II diabetes mellitus on hemodialysis for ten years, status post living related donor kidney transplant from her son three years prior to this presentation, parathyroidectomy, and atrial fibrillation on warfarin presented to our institution with progressively worsening, severely tender bilateral thigh lesions that were diagnosed as calciphylaxis. She was treated with sodium thiosulfate infusions for six months and continues to do well. Conclusions: Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), has traditionally been associated with ESRD patients on maintenance dialysis, however several nonuremic cases of CUA have been reported in recent years. Multiple pathophysiologic mechanisms for CUA development have been proposed expanding the scope of known risk factors and possible triggers. CUA can be a life-threatening condition that is important for clinicians to recognize and treat as soon as possible.
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Affiliation(s)
- Maria Srour
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Bahar Bastani
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
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Bastani B. The iranian model as a potential solution for the current kidney shortage crisis. Int Braz J Urol 2018; 45:194-196. [PMID: 30521163 PMCID: PMC6442125 DOI: 10.1590/s1677-5538.ibju.2018.0441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/15/2018] [Indexed: 11/21/2022] Open
Affiliation(s)
- Bahar Bastani
- Division of Nephrology, Saint Louis University Health Science Center, Saint Louis, MO, USA
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Fry-Revere S, Chen D, Bastani B, Golestani S, Agarwal R, Kugathasan H, Le M. Introducing an Exploitation/Fair Dealings Scale for Evaluating Living Organ Donor Policies Using Iran as the Test Case. World Medical & Health Policy 2018. [DOI: 10.1002/wmh3.264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fry-Revere S, Chen D, Bastani B, Golestani S, Agarwal R, Kugathasan H, Le M. Coercion, dissatisfaction, and social stigma: an ethnographic study of compensated living kidney donation in Iran. Int Urol Nephrol 2018; 52:2403-2414. [PMID: 29480443 DOI: 10.1007/s11255-018-1824-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 02/12/2018] [Indexed: 11/29/2022]
Abstract
This article updates the qualitative research on Iran reported in the 2012 article by Tong et al. "The experiences of commercial kidney donors: thematic synthesis of qualitative research" (Tong et al. in Transpl Int 25:1138-1149, 2012). The basic approach used in the Tong et al. article is applied to a more recent and more comprehensive study of Iranian living organ donors, providing a clearer picture of what compensated organ donation is like in Iran since the national government began regulating compensated donation. Iran is the only country in the world where kidney selling is legal, regulated, and subsidized by the national government. This article focuses on three themes: (1) coercion and other pressures to donate, (2) donor satisfaction with their donation experience, and (3) whether donors fear social stigma. We found no evidence of coercion, but 68% of the paid living organ donors interviewed felt pressure to donate due to extreme poverty or other family pressures. Even though 27% of the living kidney donors interviewed said they were satisfied with their donation experience, 74% had complaints about the donation process or its results, including some of the donors who said they were satisfied. In addition, 84% of donors indicated they feared experiencing social stigma because of their kidney donation.
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Affiliation(s)
- Sigrid Fry-Revere
- American Living Organ Donor Network, 40357 Featherbed Lane, Lovettsville, VA, 20180, USA.
| | | | - Bahar Bastani
- Saint Louis University School of Medicine, Saint Louis, MO, USA
| | | | | | | | - Melissa Le
- University of Virginia, Charlottesville, VA, USA
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Bastani B. Phospholipase A2 receptor (PLA2R) related membranous nephropathy - not specific for idiopathic cases any more. J Nephropathol 2017. [DOI: 10.15171/jnp.2018.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Najafi H, Mohamadi Yarijani Z, Changizi-Ashtiyani S, Mansouri K, Modarresi M, Madani SH, Bastani B. Protective effect of Malva sylvestris L. extract in ischemia-reperfusion induced acute kidney and remote liver injury. PLoS One 2017; 12:e0188270. [PMID: 29155898 PMCID: PMC5695808 DOI: 10.1371/journal.pone.0188270] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/03/2017] [Indexed: 01/02/2023] Open
Abstract
Mallow (Malva sylvestris L.) has had medicinal and therapeutic uses in addition to its oral consumption. The present study was conducted to examine the protective effect of Malva sylvestris L. extract on ischemia-reperfusion-induced kidney injury and remote organ injuries in the liver. Before ischemia-reperfusion, rats in the different groups received intraperitoneal normal saline or mallow extract at the doses of 200, 400 or 600 mg/kg of body weight. After 30-minutes of bilateral renal ischemia followed by 24-hours of reperfusion, tissue damage in the kidney and liver samples were determined through studying H&E-stained slides under a light microscope. The degree of leukocyte infiltration and tissue mRNA expressions of TNF- and ICAM-1 were then measured to examine the degree of renal inflammation. The renal tissue MDA and FRAP levels were measured for determining the amount of oxidative stress. Plasma concentrations of creatinine, urea, ALT and ALP were also measured. Ischemia-reperfusion led to a significant increase in plasma concentrations of creatinine, urea, ALT and ALP, and renal tissue MDA, and a significant decrease in renal tissue FRAP. The expression of pro-inflammatory factors in the kidney tissue, the level of leukocyte infiltration and the amount of tissue damage in the kidney and liver also increased. Pretreatment by mallow extract led to a significant improvement in all the variables measured. The 200- and 400-mg doses yielded better results in most parameters compared to the 600-mg dose. The findings showed that mallow extract protects the kidney against ischemia-reperfusion and reduces remote organ injury in the liver.
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Affiliation(s)
- Houshang Najafi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Saeed Changizi-Ashtiyani
- Department of Physiology, School of Paramedical Sciences, Arak University of Medical Sciences, Arak, Iran
| | - Kamran Mansouri
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Modarresi
- Pharmacognosy and Biotechnology Department, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Hamid Madani
- Department of Pathology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Bahar Bastani
- Division of Nephrology, School of Medicine, Saint Louis University, Saint Louis, Missouri, United States of America
- * E-mail:
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Shadman A, Bastani B. Evaluation and Management of Kidney Calculi. Iran J Kidney Dis 2017; 11:395-407. [PMID: 29190598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/14/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The recent change in the view towards nephrolithiasis from a benign isolated disease to a disorder associated with numerous systemic and chronic conditions has added to the importance of a more thorough and timely diagnostic and therapeutic intervention. MATERIALS AND METHODS Both original and review articles found via the PubMed search on recent evaluation and management strategies of urinary calculi were reviewed. These resources were integrated with the authors' knowledge of the field. RESULTS The emerging evidence attests to the association of nephrolithiasis with many morbid and fatal diseases, such as coronary heart disease, ischemic stroke, hypertension, chronic kidney insufficiency, malignancies, and bone loss, as well as the economic burden of urinary calculus on health system and work force. CONCLUSIONS Findings of this review justify a timely and comprehensive workup and dietary-therapeutic measures in order to prevent, treat, and control the associated complications of this condition.
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Affiliation(s)
| | - Bahar Bastani
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, Saint Louis, Missouri, USA.
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Bastani B. The New Trend in Medicine. Am J Med 2017; 130:509. [PMID: 27894735 DOI: 10.1016/j.amjmed.2016.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 10/17/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Bahar Bastani
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, Mo
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Shadman A, Bastani B. Kidney Calculi: Pathophysiology and as a Systemic Disorder. Iran J Kidney Dis 2017; 11:180-191. [PMID: 28575878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 01/23/2017] [Indexed: 06/07/2023]
Abstract
The pathophysiology of urinary stone formation is complex, involving a combination of metabolic, genetic, and environmental factors. Over the past decades, remarkable advances have been emerged in the understanding of the pathogenesis, diagnosis, and treatment of calcium kidney calculi. For this review, both original and review articles were found via PubMed search on pathophysiology, diagnosis, and management of urinary calculi. These resources were integrated with the authors' knowledge of the field. Nephrolithiasis is suggested to be associated with systemic disorders, including chronic kidney insufficiency, hematologic malignancies, endocrine disorders, autoimmune diseases, inflammatory bowel diseases, bone loss and fractures, hypertension, type 2 diabetes mellitus, metabolic syndrome, and vascular diseases like coronary heart diseases and most recently ischemic strokes. This is changing the perspective of nephrolithiasis from an isolated disorder to a systemic disease that justifies further research in understanding the underlying mechanisms and elaborating diagnostic-therapeutic options.
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Affiliation(s)
| | - Bahar Bastani
- Division of Nephrology, Department of Internal Medicine, Saint Louis University, Saint Louis, Missouri, USA.
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Golish J, Sleeper G, Bastani B, Rashidi M, West D. 0574 SLEEP-REPOSITIONING IS A REQUIRED COMPONENT IN MAKING NASAL EPAP EFFECTIVE IN CONTROLLING OSA. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Khneizer G, Al-Taee A, Mallick MS, Bastani B. Chronic dietary oxalate nephropathy after intensive dietary weight loss regimen. J Nephropathol 2017; 6:126-129. [PMID: 28975090 PMCID: PMC5607971 DOI: 10.15171/jnp.2017.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/25/2017] [Indexed: 11/11/2022] Open
Abstract
Background:
Hyperoxaluria has been associated with nephrolithiasis as well as acute and chronic kidney disease. We present a case of end stage renal failure caused by excessive dietary oxalate intake in a dietary weight loss regimen.
Case Presentation:
A 51-year-old Caucasian male with the past medical history of type 2 diabetes mellitus, gout, hypertension and morbid obesity was referred to the primary care clinic after being found pale and easily fatigued. The patient had lost 36 kg over a 7-month period by implementing exercise and intense dietary measures that included 6 meals of spinach, kale, berries, and nuts. Physical examination revealed a blood pressure of 188/93 mm Hg with sunken eyes and dry mucus membranes. Laboratory workup was notable for blood urea nitrogen of 122 mg/dL, creatinine of 12 mg/dL, and estimated glomerular filtration rate (eGFR) of 4.4 mL/min/1.73m2. Patient denied any history of renal disease or renal stones, or taking herbal products, non-steroidal anti-inflammatory drugs, antifreeze (ethylene glycol), or any type of "diet pills." Family history was unremarkable for any renal diseases. After failing intravenous fluid resuscitation, patient was started on maintenance hemodialysis. Abdominal imaging was consistent with chronic renal parenchymal disease with no evidence of nephrolithiasis. Renal biopsy revealed numerous polarized oxalate crystal deposition and diabetic nephropathy class IIA. At this point the patient was instructed to adopt a low oxalate diet. A 24-hour urine collection was remarkable for pH 4.7, citrate <50 mg, and oxalate 46 mg. Importantly, serum oxalate level was undetectable. Repeat renal biopsy 5 months later while patient was still on maintenance hemodialysis revealed persistence of extensive oxalate crystal deposition. Patient has been referred for evaluation for renal transplantation.
Conclusions:
Clinicians need to maintain a high index of suspicion for dietary hyperoxaluria as a potential etiology for acute or chronic kidney failure, particularly in patients pursuing intensive dietary weight loss intervention
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Affiliation(s)
- Gebran Khneizer
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Ahmad Al-Taee
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Meher S Mallick
- Saint Louis Nephrology Associates, Saint Louis, Missouri, USA
| | - Bahar Bastani
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
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Khneizer G, Al-Taee A, Bastani B. Self-limited membranous nephropathy after intravitreal bevacizumab therapy for age-related macular degeneration. J Nephropathol 2017; 6:134-137. [PMID: 28975092 PMCID: PMC5607973 DOI: 10.15171/jnp.2017.23] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 01/30/2017] [Indexed: 11/11/2022] Open
Abstract
Background:
Monoclonal antibodies targeting vascular endothelial growth factor (VEGF), such as bevacizumab, are administered intravitreally for the treatment of wet or exudative age-related macular degeneration (ARMD). Systemic use of bevacizumab has been linked to a wide range of renal adverse effects including proteinuria and hypertension.
Case Presentation:
We present the case of a 77-year-old Caucasian male with a past medical history of hypertension, vitamin D deficiency and paroxysmal atrial fibrillation who presented to primary care clinic with a 2-week history of bilateral lower extremity edema, 2 months after completing four monthly intravitreal injections of bevacizumab for ARMD. Examination was remarkable for blood pressure of 187/91 mm Hg and severe bilateral lower extremity edema. Work up revealed unremarkable complete blood count (CBC), comprehensive metabolic panel (CMP), lipid panel, and echocardiography, except for 491 mg/dL albuminuria. Metoprolol and furosemide were added to hydrochlorothiazide and lisinopril. Work up by nephrology consult team five months later was notable for a urinalysis revealing 3 red blood cells/high power field (RBC/HPF), 24-hour urine protein of 8.6 g, and serum creatinine of 1.2 mg/dL. Viral hepatitis panel, total complement activity (CH50), C3, C4, anti-nuclear antibody (ANA), anti-neutrophil cytoplasmic antibody (ANCA), serum and urine protein electrophoresis were all unremarkable. Renal biopsy was consistent with membranous nephropathy. Age-appropriate cancer screening was negative. Random urine protein-to-creatinine ratio declined to 2 g/g and then to 0.56 g/g at 7 and 10 months follow up, respectively. Serum blood urea nitrogen (BUN) and creatinine remained normal throughout the course of illness and patient did not require any immunosuppressive treatment.
Conclusions:
The wide range of nephrotoxicity after systemic bevacizumab has been well documented. Our case describes a self-limited biopsy-proven membranous nephropathy after intravitreal bevacizumab injections.
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Affiliation(s)
- Gebran Khneizer
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Ahmad Al-Taee
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Bahar Bastani
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
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Abstract
Background: Milrinone is a phosphodiesterase type III inhibitor with positive inotropic and vasodilatory effects used in patients with severe congestive heart failure (CHF). Objectives: To determine the incidence rate of acute renal failure (ARF) associated with milrinone therapy. Methods: Medical records of 116 patients with cardiomyopathy/severe CHF who received milrinone were reviewed from January 1993 to January 1996. Twenty-nine patients were excluded, resulting in 87 patients, 4 of whom received milrinone twice. Results: During a 3-year period, 11 of 91 milrinone therapies became complicated with ARF (incidence 12%). The patients' age (mean ± SD) was 52.3 ± 13.6 years, baseline serum creatinine (SCr) was 1.6 ± 1.0 mg/dL, milrinone dose was 0.47 ± 0.16 μg/kg/min, and mean duration of therapy was 6.5 ± 10.6 days. Fourteen treatments were <24 hours, 2 (14%) of which were complicated with ARF; of the remaining 77 treatments (≥24 h), 9 (11.7%) were complicated with ARF. Their peak SCr was 3.2 ± 1.5 mg/dL and time to peak SCr was 4.9 ± 2.8 days. There was no significant difference in the incidence of ARF in patients who received therapy for <24 hours versus ≥24 hours; in the prevalence rate of diabetes mellitus, hypertension, coronary artery disease; or in baseline SCr, milrinone dose, and duration of therapy between patients who did and did not develop ARF. Conclusions: We found a 12% incidence of ARF in patients receiving milrinone therapy for severe CHF, which in the absence of an appropriate control group could be the aggregate effects of milrinone therapy and severe CHF.
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Affiliation(s)
- Kamal Amin
- KAMAL AMIN MD, Nephrology Fellow, Division of Nephrology, Department of Internal Medicine, St. Louis University School of Medicine, St. Louis, MO
| | - Bahar Bastani
- BAHAR BASTANI MD, Professor of Internal Medicine and Nephrology, Division of Nephrology, Department of Internal Medicine, St. Louis University School of Medicine
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Changizi-Ashtiyani S, Alizadeh M, Najafi H, Babaei S, Khazaei M, Jafari M, Hossaini N, Avan A, Bastani B. Physalis alkekengi and Alhagi maurorum ameliorate the side effect of cisplatin-induced nephrotoxicity. Cancer Gene Ther 2016; 23:235-40. [PMID: 27255563 DOI: 10.1038/cgt.2016.24] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 05/09/2016] [Indexed: 02/06/2023]
Abstract
Cisplatin is frequently being used for the treatment of different tumors, although the application of this agent is associated with nephrotoxicity. Here, we explored the antioxidant and anti-inflammatory activities of Physalis alkekengi and Alhagi maurorum; 400 mg kg(-1) per day P. alkekengi and 100 mg kg(-1) per day A. maurorum were administered in rats, orally for 10 days after a single dose of 7 mg kg(-1) intraperitoneal cisplatin. The concentrations of creatinine, urea-nitrogen, and relative and absolute excretion of sodium/potassium were evaluated before/after therapy. Levels of malondialdehyde (MDA) and ferric-reducing antioxidant power (FRAP) were measured to assess the oxidative stress induced by cisplatin. Moreover, tissues sections were used for histological analyses and evaluation of the degree of tissue damage. Cisplatin increased serum levels of creatinine and urea-nitrogen, relative/absolute excretion of sodium/potassium, and MDA, whereas decreased FRAP level. Interestingly, P. alkekengi or A. maurorum were able to reduce the level of the renal function markers as well as the levels of sodium/potassium. This effect was more pronounced by P. alkekengi. Moreover, cisplatin induced pathological damage in kidney, whereas treatment with these agents improved this condition. Our findings demonstrate the potential therapeutic impact of P. alkekengi and A. maurorum for improving cisplatin-induced nephrotoxicity, supporting further investigations on the novel potential clinical application of these agents for patients being treated with cisplatin to ameliorate cisplatin-induced nephrotoxicity.
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Affiliation(s)
| | - M Alizadeh
- Student Research Committee, Arak University of Medical Sciences, Arak, Iran
| | - H Najafi
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - S Babaei
- Department of Histology, Arak University of Medical Sciences, Arak, Iran
| | - M Khazaei
- Student Research Committee, Arak University of Medical Sciences, Arak, Iran
| | - M Jafari
- Student Research Committee, Arak University of Medical Sciences, Arak, Iran
| | - N Hossaini
- Department of Medicinal Plants, University of Arak, Arak, Iran
| | - A Avan
- Molecular Medicine Group, Department of Modern Sciences and Technologies, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - B Bastani
- Division of Nephrology, School of Medicine, Saint Louis University, Saint Louis, MO, USA
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Affiliation(s)
- Bahar Bastani
- Division of Nephrology, Saint Louis University School of Medicine, Saint Louis, USA
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Nesselhauf N, Strutt J, Bastani B. Evaluation of leflunomide for the treatment of BK viremia and biopsy proven BK nephropathy; a single center experience. J Nephropathol 2015; 5:34-7. [PMID: 27047808 PMCID: PMC4790185 DOI: 10.15171/jnp.2016.06] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 12/13/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND BK virus reactivation is a significant complication following renal transplantation that can result in graft failure. Reduction of immunosuppression and substitution of leflunomide for mycophenolate mofetil (MMF) has been used to treat this entity. OBJECTIVES To evaluate the use of leflunomide in BK viremia (BKV) and biopsy proven BK nephropathy (BKN) in kidney and kidney-pancreas transplant recipients. PATIENTS AND METHODS We retrospectively reviewed 28 kidney and kidney-pancreas transplant recipients who had received leflunomide for BKV from January 2006 to November 2012. Demographics, time to BKV diagnosis, biopsy findings, rejection episodes, and laboratory data were recorded. RESULTS The average (mean ± SD) time to BKV from time of transplant was 316.1 ± 368.0 days (62-1708 days). At time of diagnosis, 64% of patients had their maintenance immunosuppression reduced. The indications for leflunomide administration were; BKV and biopsy proven acute rejection (BPAR) (50%), biopsy proven BKN (18%), or persistent BKV (25%). Therapeutic levels (50-100 mcg/mL) were achieved in only 54% of patients, and 60% of them had required a leflunomide dose of at least 60 mg/day. BK virus was cleared from the serum on average of 151 ± 145.2 days (17-476 days). At study commencement, 29% of patients had remained on leflunomide due to persistent BKV. CONCLUSIONS In our study, most patients required at least a 60 mg daily dose of leflunomide to achieve therapeutic levels and to clear the virus compared to the standard 40 mg daily dose. Delaying therapy may result in progressive BKV and BKN.
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Affiliation(s)
- Nicole Nesselhauf
- Department of Pharmacy, SSM Saint Louis University Hospital, Saint Louis, Missouri, USA
| | - Jaclyn Strutt
- Department of Pharmacy, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
| | - Bahar Bastani
- Division of Nephrology, Saint Louis University, School of Medicine, Saint Louis, Missouri, USA
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Bastani B. The worsening transplant organ shortage in USA; desperate times demand innovative solutions. J Nephropathol 2015; 4:105-9. [PMID: 26457256 PMCID: PMC4596293 DOI: 10.12860/jnp.2015.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 06/22/2015] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bahar Bastani
- Division of Nephrology, Saint Louis University School of Medicine. Medical director of kidney transplantation, Saint Louis University School of Medicine, Saint Louis, USA
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Hamidian Jahromi A, Fry-Revere S, Bastani B. A Revised Iranian Model of Organ Donation as an Answer to the Current Organ Shortage Crisis. Iran J Kidney Dis 2015; 9:354-360. [PMID: 26338158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 03/13/2015] [Accepted: 04/19/2015] [Indexed: 06/05/2023]
Abstract
Kidney transplantation has become the treatment of choice for patients with end-stage renal disease. Six decades of success in the field of transplantation have made it possible to save thousands of lives every year. Unfortunately, in recent years success has been overshadowed by an ever-growing shortage of organs. In the United States, there are currently more than 100 000 patients waiting for kidneys. However, the supply of kidneys (combined cadaveric and live donations) has stagnated around 17 000 per year. The ever-widening gap between demand and supply has resulted in an illegal black market and unethical transplant tourism of global proportions. While we believe there is much room to improve the Iranian model of regulated incentivized live kidney donation, with some significant revisions, the Iranian Model could serve as an example for how other countries could make significant strides to lessening their own organ shortage crises.
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Affiliation(s)
| | | | - Bahar Bastani
- Division of Nephrology, Department of Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA.
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Qazi RA, Bastani B. Co-existence of thin basement membrane nephropathy with other glomerular pathologies; a single center experience. J Nephropathol 2015; 4:43-7. [PMID: 25964888 PMCID: PMC4417669 DOI: 10.12860/jnp.2015.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 09/29/2014] [Indexed: 11/21/2022] Open
Abstract
Background: The co-existence of thin basement membrane nephropathy (TBMN) and another glomerular pathology portends a worse prognosis than TBMN alone.
Objectives: The purpose of our study was to investigate the prevalence of TBMN and associated glomerular pathologies at our institution.
Patients and Methods: We reviewed all renal biopsies performed at Saint Louis University hospital over a 7-year period. We excluded all post transplant biopsies, and biopsies showing diabetic glomerulopathy, membranoproliferative glomerulopathy, membranous glomerulopathy, and biopsies where no electron microscopy or immunofluorescent studies were done. All other biopsies were included.
Results: A total of 634 biopsies were included in the study. The prevalence of TBMN was 47 (7.4%), of whom 17 (36.2%) had TBMN alone. In the remaining 30 (63.8%) patients TBMN was associated with other glomerular pathologies: IgAN 9 (19.1%) and FSGS 9 (19.1%). We found significantly higher prevalence of IgAN in patients with TBMN versus all biopsies (19.1% vs. 7.7%, respectively, P = 0.002). We found significant similarities in biopsy indications for TBMN and IgAN group.
Conclusions: Around two thirds of the cases of TBMN were associated with other glomerular pathologies. The prevalence of IgAN, but not focal segmental glomerulosclerosis, was significantly higher in patients with TBMN as compared to the general renal biopsy specimens.
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Affiliation(s)
- Rizwan A Qazi
- Department of Internal Medicine, Division of Nephrology, University School of Medicine, Saint Louis, USA
| | - Bahar Bastani
- Department of Internal Medicine, Division of Nephrology, University School of Medicine, Saint Louis, USA
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Roozbeh J, Bagheri-Lankarani K, Mohaghegh P, Raeesjalali G, Behzadi S, Sagheb M, Vossoughi M, Bastani B. A randomized pilot trial on the effect of granulocyte-colony stimulating factor on antibody response in hemodialysis patients who had not responded to routine hepatitis B virus vaccine. J Nephropathol 2015; 4:13-7. [PMID: 25657980 PMCID: PMC4316580 DOI: 10.12860/jnp.2015.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 11/14/2014] [Indexed: 02/05/2023] Open
Abstract
Background: Various strategies have been applied to improve the response to hepatitis B virus (HBV) vaccination in hemodialysis patients.
Objectives: 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).
Patients and Methods: 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.
Results: 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.
Conclusions: 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.
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Affiliation(s)
- Jamshid Roozbeh
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ; Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Poopak Mohaghegh
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Saeed Behzadi
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Sagheb
- Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Vossoughi
- Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahar Bastani
- Division of Nephrology, Saint Louis University, School of Medicine, Saint Louis, Missouri, USA
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