A. Ibis

Early Assessment of Renal Resistance Index and Long-Term Renal Function in Renal Transplant Recipients

Background. The effect of the intrarenal arterial resistance index (RI) on long-term renal functions is not well known. We examined the predictive value of intrarenal RI on long-term allograft outcomes. Methods. We retrospectively investigated 121 stable renal transplant recipients, followed for a mean of 63.21 ± 19.9 months after renal transplant. Patients with complications during the first six months after transplant were not included. Color Doppler ultrasonography was done to calculate the intrarenal RI within the first four weeks after transplant. Results. Older recipient age, high pulse pressure, active smoking, and proteinuria were associated with a higher intrarenal RI. Multivariate analyses revealed that renal RI and donor age were independent predictors of allograft outcome. Kaplan-Meier estimates of cumulative graft survival were significantly worse in patients who had an RI of 0.7 or more than they were in patients who had an RI of less than 0.7 (p = .005). Development of chronic allograft nephropathy (CAN) was significantly higher in patients who had an RI of 0.7 or more (p = .02). Conclusions. Renal RI determined within the first month after renal transplant predicts long-term allograft function and development of CAN in renal transplant recipients.

Is there a link between hyperuricemia, morning blood pressure surge, and non-dipping blood pressure pattern in metabolic syndrome patients?

Background: Hypertensive patients usually have a blunted nocturnal decrease, or even increase, in blood pressure during sleep. There is also a tendency for increased occurrence of cardiovascular events between 6 and 12 am due to increased morning blood pressure surge (MBPS). Co-occurrence of metabolic syndrome (MetS) and hypertension is also a common problem. Hyperuricemia might trigger the development of hypertension, chronic renal failure, and insulin resistance. In this study, we aimed to determine whether there is a relationship between hyperuricemia, MetS, nocturnal blood pressure changes, and MBPS. Method: A total of 81 newly diagnosed hypertensive MetS patients were included in this study. Ambulatory blood pressure monitoring of patients was done and patients’ height, weight, and waist and hip circumferences were recorded. Fasting blood glucose (FBG), lipid profile, creatinine, potassium, uric acid, hematocrit levels were studied. Results: Non-dipper (ie, those whose blood pressure did not drop overnight) patients had higher waist–hip ratios (WHR) (P = 0.003), uric acid (P = 0.0001), FBG (P = 0.001), total and low-density lipoprotein cholesterol levels (P = 0.0001). Risk analysis revealed that hyperuricemia was a risk factor for non-dipping pattern (P < 0.0001, odds ratio = 8.1, 95% confidence interval = 1.9–33.7). Patients in the highest quadrant for uric acid levels had higher FBG (P = 0.001), low-density lipoprotein cholesterol (P = 0.017), WHR (P = 0.01), MBPS (P = 0.003), and night diastolic blood pressure compared with lowest quadrant patients (P = 0.013). Uric acid levels were also positively correlated with night ambulatory blood pressure (ABP) (r = 0.268, P =0.05), night diastolic blood pressure (r =0.3, P =0.05), and MBPS (r =0.3, P =0.05). Conclusion: Evaluation of hypertensive patients should also include an assessment of uric acid level and anthropometric measurements such as abdominal obesity. Hyperuricemia seems to be closely related to undesired blood pressure patterns and this may signal to the clinician that an appropriate therapeutic approach is required.

Posttransplant proteinuria is associated with higher risk of cardiovascular disease and graft failure in renal transplant patients.

In this study, we sought to determine whether proteinuria after renal transplantation was associated with cardiovascular disease (CVD), patient survival, and long-term allograft survival. One hundred twenty-six patients included 102 males and 24 females of mean age 30.7 +/- 8.9 years. Their mean follow-up was 63.21 +/- 19.9 months. All patients were evaluated for CVD, namely, ischemic heart disease, cerebrovascular disease, and peripheral vascular disease. Proteinuria was defined as urinary protein >or=500 mg/d which persisted for >6 months after transplantation. We retrospectively examined pre- and posttransplant data, including sex, age at transplantation, smoking, pretransplant dialysis duration, donor status, number of acute rejection episodes, body mass index, systolic and diastolic blood pressure levels, lipid profile and other biochemical parameters, immunosuppressive regimens, as well as pulse steroid dose. Proteinuria was significantly associated with CVD (P = .001; RR = 6.43; confidence interval [CI] 2.15-19.22). Patients with proteinuria showed significantly lower graft survival rates than those without proteinuria (58.62% vs 80.41%; P = .02). The mean time to appearance of proteinuria was 14.1 +/- 11.4 months (range, 1-36 months). There was no significant association between proteinuria and patient survival. Patients with persistent proteinuria displayed a greater number of acute rejection episodes (1.20 +/- 1.17 vs 0.62 +/- 0.85; P = .004) and higher pulse steroid dosages (4380.0 +/- 3123.4 vs 2800.0 +/- 2766.7; P = .022). In conclusion, persistent proteinuria is a strong risk factor for CVD among renal transplant patients. Therefore, an etiologic search and antiproteinuric strategy should be considered routinely to improve patient and graft outcomes.

The influence of hepatitis C infection activity on oxidative stress markers and erythropoietin requirement in hemodialysis patients.

We sought to expose the possible effect of hepatitis C virus (HCV) infection on oxidative stress indicators, nutritional status, and erythropoietin (rHuEPO) requirements in maintenance hemodialysis (MHD) patients. A total of 111 MHD patients (69 males, 42 females; mean age 51.3 +/- 13.0 years; MHD duration 78.5 +/- 52.1 months) and 46 healthy controls were enrolled in the study. We excluded patients with hepatitis B infection or malignancy. Indicators for oxidative status were studied in plasma samples obtained at the beginning of a clinically stable MHD session. Measurements were performed for plasma superoxide dismutase, glutathione peroxidase (antioxidative agents), and malonyldialdehyde (MDA; oxidative agent) by spectrophotometric methods. All patients were analyzed for the presence of anti-HCV; positive patients were also evaluated for the presence of HCV RNA. MHD patients were divided into three groups according to HCV infection status: group I (anti-HCV-positive, HCV-RNA-negative; n = 22); group II (anti-HCV-positive, HCV-RNA-positive; n = 22), and group III (anti-HCV-negative; n = 67). According to the analyses, MHD patients showed higher plasma oxidative stress indicators and lower antioxidative indicator levels compared to controls (P < .0001). MHD patients also displayed lower albumin and higher C-reactive protein (CRP) levels compared to controls (P < .0001). Antioxidant levels were decreased significantly from group I to III (P < .0001). MDA levels significantly increased from group I to III (P < 0.01). HCV-RNA-positive patients showed lowest albumin and highest CRP levels and rHuEPO requirements. Although alanine transferase (ALT) levels were in the normal range, group II patients had significantly higher ALT levels than the other groups (P < .01). In conclusion, we observed negative effects of active HCV infection on oxidative stress and rHuEPO requirements. In contrast, we detected that clinically inactive HCV infection was associated with reduced oxidative stress and rHuEPO requirements compared with active HCV infection and HCV-negative patients.