Glucocorticoid Receptor Polymorphisms and Avascular Osteonecrosis After Kidney Transplantation

INTRODUCTION

Glucocorticoids (GCs) are commonly prescribed as immunosuppressive agents after kidney transplantation and their most common non-traumatic adverse effect is Avascular Necrosis (AVN) of the femoral head. In this regard, this study aimed to evaluate the glucocorticoid receptor (GR) polymorphisms among kidney transplant recipients and their potential role as a risk factor for the incidence of AVN.

METHODS

In this study, 99 renal transplant recipients were evaluated for the correlations of GR polymorphisms including N363S (rs6195), BclI (rs41423247), ER22/23EK (rs6189/rs6190), and A3669G (rs6198) with AVN after renal transplantation.

RESULTS

Results showed that none of the renal-transplanted patients neither with GC hypersensitive polymorphisms (N363S and BclI) nor with GC-resistant polymorphisms (A3669G and ER22/23EK) developed AVN (P > .05). In addition, the medications of the renal recipients with AVN were significantly different from the nonAVN patients (P < .001).

CONCLUSION

The study results indicate that the GR polymorphisms have no critical roles in the susceptibility to AVN after renal transplantation. However, further studies to confirm the results are recommended.  DOI: 10.52547/ijkd.7221.

Analysis of glucocorticoid receptor gene polymorphisms in kidney recipients with post-transplant diabetes

Introduction: Post-transplant diabetes mellitus (PTDM) is a severe and common metabolic problem after transplantation. Glucocorticoid receptor (GR) is encoded by the NR3C1 gene and it seems that polymorphisms in this gene lead to altering insulin sensitivity. Objectives: This study aimed to evaluate the frequency of four common polymorphisms in the NR3C1 gene of renal recipients with and without PTDM. Patients and Methods: Blood samples were collected from 32 PTDM and 59 non-diabetic renal-transplanted patients. After DNA extraction, DNA fragments were amplified and directly sequenced using specific primers. Data analysis was performed with SPSS 22.0 software. Results: There was no significant correlation between diabetes incidence and the four investigated polymorphisms of the GR gene. Nevertheless, diabetic patients’ age was higher than non-diabetic patients. Additionally, transplant acute rejection (AR) in diabetic patients was found to be more than non-diabetic patients. Conclusion: Based on gathered information in this research, none of the studied polymorphisms affected the development of PTDM. Further investigations should be conducted in a large sample size.

Immunosuppressant Management in Renal Transplant Patients with COVID-19

The coronavirus disease 2019 (COVID-19) pandemic poses a special risk for both immunosuppressed patients, especially transplant recipients. Although the knowledge about this infection is growing, many uncertainties remain, particularly regarding the kidney. Kidney transplant recipients (KDRs) should be considered immunocompromised hosts since a potential risk for infection, comorbidity, and immunosuppression exposure exists. Additionally, the management of immunosuppressive agents in KDRs remains challenging. Potential drug interactions with immunosuppressive treatment escalated the risk of unwanted side effects. In this review, we aimed to attain an augmented awareness and improved management immunosuppressant for COVID-19 KDRs.

Migrasomes and exosomes; different types of messaging vesicles in podocytes

Podocytes, highly specified kidney epithelial cells, live under several pathological stimuli and stresses during which they adapt themselves to keep homeostasis. Nevertheless, under extreme stress, a complex scenario of podocyte damage and its consequences occur. Podocyte damage causes foot process effacement and their detachment from the glomerular basement membrane, leading to proteinuria. Podocyte-derived extracellular vesicles (pEVs), mainly microparticles and exosomes are considered as signaling mediators of intercellular communication. Recently, it has been shown that throughout the injury-related migration procedure, podocytes are capable of releasing the injury-related migrasomes. Evidence indicates that at the early stages of glomerular disorders, increased levels of pEVs are observed in urine. At the early stage of nephropathy, pEVs especially migrasomes seem to be more sensitive and reliable indicators of podocyte stress and/or damage than proteinuria. This review highlights the current knowledge of pEVs and their values for the diagnosis of different kidney diseases.

The clinical significance of the glucocorticoid receptors: Genetics and epigenetics

The impacts of glucocorticoids (GCs) are mainly mediated by a nuclear receptor (GR) existing in almost every tissue. The GR regulates a wide range of physiological functions, including inflammation, cell metabolism, and differentiation playing a major role in cellular responses to GCs and stress. Therefore, the dysregulation or disruption of GR can cause deficiencies in the adaptation to stress and the preservation of homeostasis. The number of GR polymorphisms associated with different diseases has been mounting per year. Tackling these clinical complications obliges a comprehensive understanding of the molecular network action of GCs at the level of the GR structure and its signaling pathways. Beyond genetic variation in the GR gene, epigenetic changes can enhance our understanding of causal factors involved in the development of diseases and identifying biomarkers. In this review, we highlight the relationships of GC receptor gene polymorphisms and epigenetics with different diseases.

Covid-19 and kidney injury: Pathophysiology and molecular mechanisms

The novel coronavirus (SARS-CoV-2) has turned into a life-threatening pandemic disease (Covid-19). About 5% of patients with Covid-19 have severe symptoms including septic shock, acute respiratory distress syndrome, and the failure of several organs, while most of them have mild symptoms. Frequently, the kidneys are involved through direct or indirect mechanisms. Kidney involvement mainly manifests itself as proteinuria and acute kidney injury (AKI). The SARS-CoV-2-induced kidney damage is expected to be multifactorial; directly it can infect the kidney podocytes and proximal tubular cells and based on an angiotensin-converting enzyme 2 (ACE2) pathway it can lead to acute tubular necrosis, protein leakage in Bowman's capsule, collapsing glomerulopathy and mitochondrial impairment. The SARS-CoV-2-driven dysregulation of the immune responses including cytokine storm, macrophage activation syndrome, and lymphopenia can be other causes of the AKI. Organ interactions, endothelial dysfunction, hypercoagulability, rhabdomyolysis, and sepsis are other potential mechanisms of AKI. Moreover, lower oxygen delivery to kidney may cause an ischaemic injury. Understanding the fundamental molecular pathways and pathophysiology of kidney injury and AKI in Covid-19 is necessary to develop management strategies and design effective therapies.

Altered Th17/Treg ratio as a possible mechanism in pathogenesis of idiopathic membranous nephropathy

Idiopathic membranous nephropathy (IMN) as a single organ autoimmune disease is a main cause of nephrotic syndrome in adults which is determined through autoantibodies to podocytes proteins. Th17/regulatory T (Treg) balance has emerged as a prominent factor in the regulation of autoimmunity. In this study, we evaluated the balance of Th17 and Treg cells, expression level of related master transcription factors, cytokines and microRNAs in mononuclear cells of peripheral blood of 30 patients with IMN and 30 healthy individuals before treatment. No significant variation was observed in Th17 cell frequency, retinoic acid receptor-related orphan nuclear receptor γt (RORɣt), signal transducer and Activator of transcription 3(STAT3), IL-17, and IL-23, while IL-21, IL-4, and IL-10 had significant increase in mRNA expression and protein level of peripheral blood mononuclear cells in IMN cases. Reduction in the percentage of Treg cells was also accompanied with significantly decreased expression of Forkhead box P3(FOXP3) and Transforming growth factor beta(TGF-β) in IMN patients compared to the control group. Our study revealed that Th17 cells themselves might not be engaged in the pathogenesis of newly diagnosed patients with IMN; however, decreased T reg cells and increased ratio of Th17/Treg lymphocytes might display a role in the pathogenesis of IMN before treatment.

Evaluation of the neutrophil to lymphocyte ratio in lupus patients with and without nephritis

Introduction: Lupus nephritis (LN) is a significant source of morbidity in cases with systemic lupus erythematosus (SLE). The efficiency of neutrophil-to-lymphocyte ratio (NLR) as an inflammatory marker has been investigated in many diseases. Objectives: In the present study, the clinical significance of NLR in SLE patients with nephritis was investigated. Patients and Methods: A total of 100 SLE patients including 20 and 80 patients with and without nephritis, respectively, and 140 controls were included in this investigation. Clinical findings and laboratory data of whole participants were reported. Inflammatory indices [e.g., erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and NLR] were compared between patients and healthy controls and also between SLE patients with and without nephritis. Results: NLR value was significantly higher in SLE patients [2.81 (1.57-16.07)] compared to controls [1.45 (1.01-4.43)] and in SLE without nephritis [2.60 (1.50-13)] compared to SLE with nephritis [5.82 (3.75-16.07)] (P < 0.001). Based on the ROC/area under curve (AUC) analysis, NLR reflected SLE disease with AUC of 0.904, cut off value of 1.98, 86.2% sensitivity, and 82% specificity. Additionally, NLR with a cut-off value of 3.64 and AUC of 0.935 indicated good sensitivity of 100% and specificity of 81.25% for discriminating SLE patients with and without nephritis. Conclusion: NLR could be considered as a discriminative parameter for SLE patients and for LN. Further investigations are required to consider NLR as an inflammatory parameter.

Circulating and cellular levels of miR-193 and miR-217 in patients with common glomerular diseases

Introduction: The definitive diagnosis of the common types of glomerular disease including FSGS (focal segmental glomerulosclerosis) and MN (membranous nephropathy) is still performed by biopsy studies, which has high risks and complications. MicroRNAs (miRNAs) can open a new horizon for the treatment and diagnosis of glomerular diseases. Objectives: In the present study, we focused on miR-217, miR-193-3p, and miR-124 expression in patients with FSGS and MN. Patients and Methods: Sixty cases (30 FSGS and 30 MN) were included based on strict criteria. A group of healthy controls were also included. The relative expression of the microRNAs was evaluated in the plasma and peripheral blood mononuclear cells (PBMCs) by quantitative real-time PCR. The association between the expression levels of microRNAs and clinicopathological parameters were also assessed. Results: There were significant differences in miR-193-3p levels between FSGS and MN group in plasma samples (P = 0.036). Furthermore, significantly decreased levels of miR-217 were observed in plasma samples of patients with NS (P = 0.026) and MN (P = 0.036) groups. Conclusion: The studied miRNAs are dysregulated in clinical samples of patients with nephrotic syndrome and they may be involved in the pathogenesis of FSGS and MN. More research is needed for understanding the relationship between these microRNAs and the pathogenesis of FSGS and MGN.

The impact of steroids on the injured podocytes in nephrotic syndrome

Nephrotic syndrome (NS), a common chronic kidney disease, embraces a variety of kidney disorders. Though Glucocorticoids (GCs) are generally used in the treatment of NS, their mechanism of action is poorly understood. A plethora of evidence indicates that podocytes are considered as the main target cells for the therapeutic strategies to prevent NS. GCs regulate the transactivation and transrepression of genes in podocytes that affect their morphological and cytoskeletal features, motility, apoptosis and survival rate. Moreover, they prevent protein leakage through the glomerular barrier membrane by affecting the synthesis, trafficking and posttranslational modifications of slit diaphragms components, podocytes' intercellular junctions. The response to the treatment is variable among different ethnics and populations and resistance to the steroids is detected in almost 50% of adult patients. Not only do pharmacokinetics and pharmacogenetics of steroids play a role in GC resistance but also the genetic variations in one or more podocyte related genes are connected with the steroid resistance in cases with NS. The focus of this review is to explain the underlying cellular and molecular mechanisms of GCs in podocytes. Understanding the mechanisms by which the GCs and GCs receptors in podocytes regulate the gene expression network and crosstalk with other molecular pathways would guarantee an optimum therapeutic benefit of steroid treatment.

Gut microbiota; an overlooked effect of phosphate binders

Hyperphosphatemia is a mineral bone-disease that increases cardiovascular complications and all-cause mortality in chronic kidney disease (CKD) patients. Oral phosphate binders absorb the dietary phosphate to prevent its high plasma levels. Moreover, they can adsorb some uremic toxins and decrease inflammation. A few recent studies highlight an ignored effect of phosphate binders on gut microbiota. Phosphorous is a major nutrient for survival and reproduction of bacteria and its intestinal concentration may impact the activity and composition of the gut microbiota. CKD is a state of an altered gut microbiome and bacterial-derived uremic toxins stimulate cardiovascular disease and systemic inflammation. The identification of the impact of phosphate binders on gut opens a new era in nephrology and fill the existing gap in interpretation of beneficial effects of phosphate binders. This review aims to highlight the impact of oral phosphate binders on the gut microbiome in CKD.

Serum Levels of CXCL10 and Vitamin D in Patients with Lupus Nephritis

INTRODUCTION

Kidney involvement is a hallmark of systemic lupus erythematosus (SLE) and evaluation of its inflammatory response is demanding. It was the aim of the present study to evaluate the levels of CXCL10 and vitamin D in serum samples of cases with active lupus nephritis (LN).

METHODS

Fifty lupus patients were enrolled in our study, 25 patients had lupus nephritis and 25 patients were without evidence of LN. Thirty-nine healthy subjects were also participated as a control group. Complete biochemical and serological parameters were measured and their correlation with serum levels of vitamin D and CXCL10 were assessed in the studied groups.

RESULTS

Serum levels of CXCL10 were significantly elevated (P≤ 0.020), while vitamin D were diminished in SLE group and active LN as compared with healthy controls and SLE patients without nephritis, respectively. CXCL10 correlated with SLE disease activity index (SLEDAI) and renal activity (P < .05), while vitamin D correlated with C3 and anti-dsDNA antibody (P < .05). Based on the receiver operator characteristic (ROC) curve analysis, CXCL10 and vitamin D levels were not better than conventional biomarkers for discriminating LN patients from non-nephritis SLE patients; however, they could differentiate most of SLE cases from healthy individuals with area under the curve (AUC) ≥ 0.703 (P < .05).

CONCLUSION

Results indicated the importance of elevated levels of CXCL10 and deficiency of vitamin D on the pathogenesis of active LN disease.

Plasma levels of miR-21, miR-150, miR-423 in patients with lupus nephritis

INTRODUCTION

MicroRNAs (miRNA) are involved in the pathogenesis of systemic lupus erythematosus (SLE), an autoimmune disease, and can be considered as diagnostic and prognostic biomarkers. Lupus nephritis (LN) remains a major challenge of SLE since it damages the kidneys in the course of the disease.

METHODS

The aim of this study was to investigate the diagnostic values of circulating miR-21, miR-148a, miR-150, and miR-423 involved in autoimmunity and kidney fibrosis in plasma samples of LN cases (N = 26) and healthy controls (N = 26) using quantitative- PCR (qPCR). The possible associations between the microRNAs and clinical parameters and their diagnostic values were also calculated.

RESULTS

The levels of circulating miR-21 (P < .001) and miR-423 (P < .05) significantly increased, while miR-150 decreased in LN (P > .05) patients as compared with healthy controls. Receiver operating characteristic (ROC) analysis indicated that miR-21 was superior in discriminating LN patients from controls with an Area Under Curve (AUC) of 0.912 [95% CI = 0.83 to 0.99, P < .001], whereas the multivariate ROC curve analysis revealed the high accuracy [AUC = 0.93, P < .001, 79% sensitivity and 83% specificity] of the miR-21, -150, and -423 to differentiate LN from controls.

CONCLUSION

The involvement of the studied miRNAs in renal fibrosis and the obtained results make it rational to speculate that they may be used as potential biomarkers in LN.

Serum tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) and IL-17 levels are associated with disease activity in systemic lupus erythematosus patients with and without nephritis

Introduction: Lupus nephritis (LN) is one of the most severe signs of systemic lupus erythematosus (SLE) and rapid diagnosis of kidney damage remains an important concern for LN. Objectives: The aim of this study was to investigate the association of the serum levels of tumor necrosis factor-like weak inducer of apoptosis (TWEAK) and interleukin 17 (IL-17) with SLE severity, renal involvement, and other clinical manifestations in lupus patients. Patients and Methods: In order to determine a better biomarker for the detection of renal damage, this study evaluated the ability of serum TWEAK (sTWEAK) and IL-17 in lupus patients with (n=25) and without (n=25) nephritis and healthy controls (n=39). Moreover, it compared the levels of these cytokines with disease activity and chronicity as well as traditional serum markers including complement C3 and C4, creatinine, and proteinuria in lupus patients. Results: Increased levels of sTWEAK and IL-17 were observed in SLE and LN groups compared to healthy controls and non-LN groups, respectively. Significant positive associations were observed between serum TWEAK and IL-17 levels and systemic lupus erythematosus disease activity index (SLEDAI), proteinuria, nephritis activity index, and some clinical manifestations (P<0.05). Discriminating the ability of the studied cytokines were not better than the utility of any markers individually. Conclusion: The serum levels of TWEAK and IL-17 in the SLE and LN groups were significantly higher than the control group and both markers were indicative of the renal disease severity; therefore, they could possibly indicate renal involvement in the lupus patients.

The importance of serum neutrophil gelatinase-associated lipocalin level in patients with lupus nephritis

Introduction: The neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a biomarker of renal damage. Objectives: The aim of this study was to assess the serum levels of NGAL (sNGAL) as a marker of disease activity in individuals with lupus nephritis (LN). Patients and Methods: This study contained 50 systemic lupus erythematosus (SLE) individuals with (n = 25) and without (n = 25) nephritis, and 39 healthy controls. The sNGAL levels were measured by ELISA. Renal function test, urinary parameters, lupus serology activity, and also calculated SLE disease activity index (SLEDAI) were analyzed to determine their associations with sNGAL. Results: The results revealed that the SLE individuals with or without nephritis had a raised serum NGAL levels as compared to control subjects (P<0.001). Additionally, sNGAL levels in LN individuals were meaningfully higher compared to those in non-LN patients (P<0.001). Serum NGAL showed a significant correlation with the SLEDAI, serum creatinine, and 24-h urinary protein (P<0.05). More importantly, sNGAL had a significant positive correlation with the activity index of LN (r = 0.616, P=0.001). In the ROC curve analysis, the measurement of sNGAL level showed a good diagnostic performance for distinguishing individuals with LN from SLE patients without renal involvement with AUC=0.902 (P<0.001), 72% sensitivity, and 99% specificity. Moreover, sNGAL could identify all of SLE patients from controls with high accuracy, AUC= 0.99, P<0.001, with 99% sensitivity, and 97% specificity. Conclusion: Serum NGAL had an association with clinical parameters and could discriminate LN from SLE patients without renal involvement. Our result suggests that serum NGAL can be used for early diagnosis of LN and identifying active LN.

Parathyroid hormone or fibroblast growth factor 23? Which one is the main determinant of the hypophosphatemia after kidney transplantation?

Introduction: Kidney transplantation restores many of the disorders accompanying endstage renal disease (ESRD). However, hypophosphatemia is common complication after renal transplantation. High levels of fibroblast growth factor 23 (FGF23) and parathyroid hormone (PTH) are two suspected factors determining the hypophosphatemia after kidney transplantation. Objectives: This observational prospective study was carried out to clarify the role of mentioned factors in hypophosphatemia after kidney transplantation. Patients and Methods: Living donor kidney transplant recipients which admitted to the ward of the renal transplantation, enrolled to the study. Parameters of bone and mineral metabolism including FGF23 and intact PTH levels were assessed. Results: High FGF23 level before transplantation was related to lower phosphate levels at 3rd month after transplantation. PTH levels showed no relationship with hypophosphatemia after kidney transplantation. Conclusion: High levels of FGF23 in ESRD patients undergoing kidney transplantation is an important determinant of hypophosphatemia in long-term follow up.

Correlation Between Circulating Visfatin and Nitric Oxide Metabolites Levels in Patients With Diabetic Nephropathy

INTRODUCTION

Diabetic nephropathy is one of the serious complications of diabetes mellitus. Visfatin is an intracellular enzyme with insulin-mimicking effects. It enhances the expression of endothelial nitric oxide (NO) synthase in renal cells. This study aimed to investigate serum levels of visfatin and NO metabolites in patients with diabetic nephropathy.

MATERIALS AND METHODS

A total of 80 diabetic patients were enrolled and classified into nephropathic and non-nephropathic patients. Serum visfatin and insulin levels were estimated using an enzyme-linked immunosorbent assay, and NO metabolites were estimated using a colorimetric assay.

RESULTS

Serum visfatin and NO metabolites levels were significantly elevated in the patients with diabetic nephropathy. Serum visfatin levels and NO metabolites were significantly higher in the nephropathic patients (P = .003; 95% confidence interval, 2.29 to 10.81; P < .001; 95% confidence interval, 3.14 to 9.46, respectively) as compared to the control group, whereas homeostatic model assessment-insulin resistance was significantly lower (P = .02; 95% confidence interval, -1.51 to -1.01).There was no correlation between body mass index, blood pressure, lipid profile, insulin, and glucose levels and serum visfatin and NO metabolites levels.

CONCLUSIONS

The results of this study demonstrated that there were high levels of visfatin and NO metabolites in patients with diabetic nephropathy. In addition, there was a positive correlation between visfatin and NO metabolites levels in nephropathic and non-nephropathic diabetic patients.

Altered levels of immune-regulatory microRNAs in plasma samples of patients with lupus nephritis

Introduction: Lupus nephritis (LN) is a major cause of mortality and morbidity in the patients with lupus, a chronic autoimmune disease. The role of genetic and epigenetic factors is emphasized in the pathogenesis of LN. The aim of the present study was to evaluate the levels of immune-regulatory microRNAs (e.g., miR-31, miR-125a, miR-142-3p, miR-146a, and miR-155) in plasma samples of patients with LN.

Methods: In this study, 26 patients with LN and 26 healthy individuals were included. The plasma levels of the microRNAs were evaluated by a quantitative real-time PCR. Moreover, the correlation of circulating plasma microRNAs with disease activity and pathological findings along with their ability to distinguish patients with LN were assessed.

Results: Plasma levels of miR-125a (P = 0.048), miR-146a (P = 0.005), and miR-155 (P< 0.001) were significantly higher in comparison between the cases and controls. The plasma level of miR-146a significantly correlated with the level of anti-double strand-DNA antibody and proteinuria. Moreover, there was a significant correlation between miR-142-3p levels and disease chronicity and activity index (P <0.05). The multivariate ROC curve analysis indicated the plasma circulating miR-125a, miR-142-3p, miR-146, and miR-155 together could discriminate most of the patients with LN from controls with area an under curve (AUC) of 0.89 [95% CI, 0.80-0.98, P<0.001], 88% sensitivity, and 78% specificity.

Conclusion: Based on the findings of the present study, the studied microRNAs may be involved in the pathogenesis and development of LN and have the potential to be used as diagnostic and therapeutic markers in LN.

Serum Levels of Vaspin and Its Correlation with Nitric Oxide in Type 2 Diabetic Patients with Nephropathy

BACKGROUND

Diabetic Nephropathy (DN), a serious and prevalent complication of diabetes, has been rapidly raising worldwide. Vaspin, as an adipokine with anti-diabetic effects, is predominantly released from visceral adipose tissue. Moreover, vaspin has the stimulatory effect on nitric oxide (NO) bioavailability through the activation of NO synthase.

OBJECTIVE

The aim of the present study was to investigate the serum levels of vaspin and their correlation with NO metabolite in diabetic patients with normal renal function and renal insufficiency.

METHODS

Volunteers patients with non-nephropathy Type 2 Diabetic Mellitus (T2DM) as control (n=40, age= 56.95±6.11 years) and patients with diabetic nephropathy (DN) (n=40, age=57.85±5.63 years) as case group were enrolled in this study, and serum samples were collected for the measurement of vaspin levels by ELISA technique. Also, serum levels of NO metabolites were calorimetrically assessed.

RESULTS

We found that vaspin levels significantly decreased in diabetic patients with nephropathic condition as compared with diabetic patients with normal renal function (p <0.04). In addition, serum levels of NO metabolites were significantly higher in diabetic patients with nephropathy in comparison with non-nephropathic diabetics (p<0.001). When patients with DN were studied, vaspin levels positively correlated with NO metabolites and Homeostasis model assessment of insulin resistance (HOMA-IR) levels.

CONCLUSION

This study showed that low serum vaspin levels may be a risk factor for nephropathy in type II diabetic patients and increased levels of NO may be a defensive mechanism in the DN.

Effect of alendronate on early bone loss of renal transplant recipients

INTRODUCTION

Renal transplant recipients (RTRs) are at risk of developing osteoporosis and osteopenia due to underlying renal osteodystrophy, hypophosphatemia, and immunosuppression. This process occurs more frequently in the first year after renal transplantation (RTX), resulting in eventual bone loss and fractures. The purpose of this study was to evaluate the effect of low-dose alendronate to prevent early bone loss after RTX.

PATIENTS AND METHODS

We prospectively studied 43 successful RTR including 22 men and 21-women with a mean overall age of 39.16±11.73 years, mean body mass index of 23.6±3.73, and mean dialysis duration of 25.73±17.67 months. We matched them based on age and sex: the alendronate-treated group received vitamin D (Vit D) during the study plus 30 mg alendronate weekly from 1 month after RTX. The control group only received Vit D. We measured serum calcium, phosphate, alkaline phosphatase, blood urea, creatinine, and intact parathyroid hormone (iPTH) at the pretransplant baseline and monthly thereafter as well as BMD of the lumbar spine, femur, and radius pretransplant baseline versus 3 and 6 months after RTX.

RESULTS

At 6 month after RTX, the lumbar BMD in the alendronate group increased significantly from 0.819±0.11 to 0.863±0.14 (P<.01), while it decreased in the control group from 0.897±0.17 to 0.817±0.16 (P<.001). There was also a significant increase in radius BMD (P<.001) and a nonsignificant increase in femoral BMD in the alendronate versus a significant decrease of femoral and radius BMD (P<.001) in the control group at 6 months. Upon multivariate analysis, there was a significant correlation between alendronate and spine BMD (r=.45, P<.001) but no linear regression between age, sex, BMI, dialysis duration of or iPTH with femoral, spine, or radius BMD changes at month 6.

CONCLUSION

Low-dose alendronate was significantly useful to mitigate fast bone loss and increase BMD immediately after RTX.

Development of a varicocele following left-sided nephrectomy in kidney donors

INTRODUCTION

Most kidney transplantation surgeons tend to prefer the left-sided kidney for donation. Because one of the veins to join the left renal vein is the left testicular (gonadal) vein, its flow may be damaged by manipulation of the left renal vein during left-sided nephrectomy. We sought to evaluate changes of the left-sided pampiniform venous plexus and testis following left-sided nephrectomy in kidney donors.

METHODS

During the present cross-sectional study (June 2007-July 2008), 54 healthy males who were candidates for left kidney donation underwent an ultrasound study of the left-sided pampiniform venous plexus diameter as well as the left testis size before and 4 months after left-sided nephrectomy.

RESULTS

The patient mean age was 25.07 +/- 2.49 years. The mean diameters of left pampiniform vein before versus 4 months after nephrectomy were 1.37 +/- 0.40 versus 2.04 +/- 0.49 mm, respectively. The mean sizes of left testis before and 4 months after nephrectomy were 21.86 +/- 2.47 versus 21.50 +/- 2.17 mL, respectively. The mean left pampiniform vein diameter significantly increased at 4 months after left-sided nephrectomy (P < .001), but the mean left testis size was not significantly changed (P = .136).

CONCLUSION

Four months after left-sided nephrectomy, the left pampiniform venous plexus diameter increased, whereas there was no significant change in left testis size. Therefore, in patients with left-sided nephrectomy, a high risk of varicocele may be predicted.

Effects of losartan and enalapril on high-sensitivity C-reactive protein and total antioxidant in renal transplant recipients with Renin-Angiotensin system polymorphisms

BACKGROUND

As renin-angiotensin system (RAS) activity may affect the severity of oxidative stress and inflammatory markers, we assessed the effects of enalapril (E) and/or losartan (L) on these markers in renal transplant recipients with RAS polymorphisms.

PATIENTS AND METHODS

After determination by PCR of RAS genotypes, consisting of the angiotensin-converting enzymes (ACE I/D), angiotensinogens (AGT M235T) and angiotensin II type 1 receptors (ATR1 A1166C), 76 recipients were recruited randomly and assigned 4 groups. The first (n = 17) and second (n = 24) groups were treated with E (E(+): 10 mg/d) and L (L(+): 50 mg/d) alone, respectively. The third positive control group (n = 17) received E + L (E(+)L(+): 10 mg/d + 50 mg/d) and the fourth negative control group (n = 18) received no medication (E(-):L(-)). High-sensitivity C-reactive protein (hs-CRP) and total antioxidant (TA) inflammatory and antioxidative markers were measured after 2 months. After a 2-week washout period, the E(+) group was changed to L(+) and vice versa in a crossover design. They were followed for another 8 weeks before retesting hs-CRP and TA. A value of P < or = .05 was considered significant.

RESULTS

After 2 and 4 months of treatment with the drug regimen, hs-CRP and TA levels were significantly decreased and consequently increased among the E(+)L(+), L(+) and E(+) groups (P < .05). On analyzing the relationship between RAS polymorphisms and baseline hs-CRP or TA levels, CC genotype of ATR1 showed lower hs-CRP levels (P = .04). However, none of the RAS polymorphisms predicted the antioxidant and anti-inflammatory response rates to the drugs (P > .05).

CONCLUSION

Although hs-CRP was lower in the CC genotype patients of ATR1 polymorphisms E and/or L reduced hs-CRP and increased TA regardless of the RAS genotype.

Findings of Doppler Sonography Do Not Correlate With Serum Lipoprotein and Total Homocysteine Concentrations in Renal Transplant Recipients

Atherosclerosis may be evaluated by structural or functional changes of the main arteries. We sought to investigate the probable associations of static and dynamic arterial changes with lipoprotein (a) and homocysteine levels, the two risk factors for atherosclerosis. Intima-media thickening and vasodilatory responses to nitroglycerine of the common carotid artery and the renal transplant artery were studied by color Doppler sonography in 75 renal transplant recipients and 30 controls. At 3, 5, and 10 minutes after 0.4 mg of sublingual nitroglycerine are measured resistive index and peak systolic velocity of the common carotid artery and renal transplant artery. Intima-media thickening in renal transplant recipients and controls were 0.86 +/- 0.34 mm and 0.74 +/- 0.14 mm (P = .05), respectively. Although intima-media thickness did not correlate with the duration of renal transplantation, it was significantly higher in older renal transplant recipients. Peak systolic velocity of common carotid artery was significantly decreased by nitroglycerine in the controls (81.8 +/- 16.7 m/s to 73.2 +/- 12.8 m/s, P = .03). This decrement was more obvious in renal transplant recipients, especially at 10 minutes (69.6 +/- 18.5 m/s vs 59.3 +/- 2 m/s, P = .01). These reductions did not correlate with intima-media thickening, latter of which also did not correlate with homocysteine concentrations, which were higher among renal transplant patients with creatinine more than 1.8 mg/dL. Basal resistive indices of the common carotid artery and renal transplant artery were higher among graft recipients with dysfunction than recipients with good function, (0.7 vs 0.59, P = .003). In conclusion, neither homocysteine nor lipoprotein(a) concentrations predict static and dynamic vascular properties.