Ali Momeni

Evaluation of spironolactone plus hydrochlorothiazide in reducing proteinuria in type 2 diabetic nephropathy

Introduction: Inhibitors of the renin–angiotensin aldosterone system (RAAS) are the basic drugs for treatment of diabetic nephropathy, as to some extent is spironolactone. The aim of the study was to evaluate the effect of spironolactone versus spironolactone plus hydrochlorothiazide in decreasing proteinuria in type 2 diabetic mellitus (T2DM) patients. Methods: In a double-blind clinical trial, 60 T2DM patients with nephropathy randomly assigned to three equal groups were enrolled. Spironolactone (50 mg/day) plus placebo, spironolactone (50 mg/day) plus hydrochlorothiazide (25 mg/day), and hydrochlorothiazide (25 mg/day) plus placebo were prescribed, respectively. The duration of treatment was three months for all patients. Urine protein was measured at the beginning and end of the study and analysis of data was performed. Results: Twenty-six of the patients were male, with a total mean age of 56.8±8.3 years. Mean 24-h urine protein was reduced in patients in groups 1 and 2 compared to the third group (p < 0.001). Serum potassium in the first group showed a significant increase of 0.26 meq/lit with mean 4.64 ± 0.28 meq/lit (p=0.002), but it did not change in the second and third groups. Conclusion: Our results showed that spironolactone plus hydrochlorothiazide is an effective and inexpensive modality in the treatment of diabetic nephropathy without increasing serum potassium.

Clinicopathological correlations in lupus nephritis; a single center experience

Background: Renal biopsies play an important role in the diagnosis, management and prognosis of patients with lupus nephritis (LN). Objectives: To determine the correlation between the pathological features of LN and the demographic, clinical and laboratory parameters. Patients and Methods: This retrospective study was conducted from 2008 to 2014 on all consecutive cases of biopsy-proven LN at a nephropathology laboratory in Iran. The demographic, clinical and laboratory data were obtained from patients’ files and the biopsy findings from the original biopsy request forms. Results: Of the 84 patients enrolled, 69 (82.2%) were females and 15 (17.8%) males. The mean age was 32.7±12 years. The mean serum creatinine was 1.5±0.94 mg/dl and the mean 24-h proteinuria, 1.6±1.9 grams. The majority of cases belonged to classes III and IV. The extracapillary proliferation was found in 42.86% of biopsies and endocapillary proliferation in 66.67% of biopsies. Patients of class IV-LN had a higher mean serum value of creatinine in comparison to class III-LN (2.19±1.09 versus 1.2±0.56 mg/dl; p= 0.0001). There was no significant difference of 24-h proteinuria between the two classes (p= 0.882). A significant association of serum creatinine with 24-h proteinuria (p= 0.041) was seen. Serum creatinine had significant positive correlation with activity percent (p< 0.001), and chronicity percent (p= 0.006), and also with proportion of glomeruli with crescents (p < 0.001). While there was a significant relationship of proteinuria with chronicity percent (p= 0.001), this association for activity percent was not significant (p= 0.094). Furthermore, the association of proteinuria with totally sclerotic glomeruli and proportion of crescents was not statistically significant (p= 0.186 and p= 0.0145 respectively). Conclusions: In conclusion, the results from our study on biopsy-proven cases of LN largely concur with the previously reported studies from Iran and other parts of the world.

Effect of silymarin in the prevention of Cisplatin nephrotoxicity, a clinical trial study.

BACKGROUND Reno-protective effect of Silymarin was studied in some studies mainly on rats. In some of these studies, Silymarin was shown to have positive effects on preventing or decreasing severity of Cisplatin nephrotoxicity. OBJECTIVE The aim of this study was to evaluate the protective effect of Silymarin on Cisplatin nephrotoxicity in adult patients with malignancy. MATERIALS AND METHODS In this clinical trial study, 60 patients with malignancy, candidate of Cisplatin treatment were randomly enrolled in two equal groups. In patients of case group, Silymarin tablet 140 mg/bid was administrated seven days before Cisplatin administration together with Cisplatin, and in control group, Cisplatin was prescribed. Blood Urea Nitrogen (BUN) and serum Creatinine (Cr) were checked at the same day and 3 and 7 days after administration of Cisplatin. RESULTS Mean age of the patients in case and control groups were 51.1±14.3 y and 51.1±13.7 y respectively (p=0.99). There was no significant difference based on BUN and serum Cr in the beginning of study and three days after administration of Cisplatin in two groups of patients; however, after two weeks, BUN and serum Cr were significantly lower in the case group compared to the control group. Also, in the case group, BUN and serum Cr decreased and in the control group, they increased after two weeks after Cisplatin administration. CONCLUSION This study showed that Silymarin can decrease Cisplatin nephrotoxicity, so because of safety profile and minor adverse effect of Silymarin, we can use it as prophylaxis against Cisplatin nephrotoxicity in various Cisplatin-contained chemotherapy regimens.

A study on the association of diabetic dermopathy with nephropathy and retinopathy in patients with type 2 diabetes mellitus

Background Diabetic dermopathy is one of the most prevalent skin complications in diabetes patients. Some studies have pointed to association of diabetic dermopathy with retinopathy and nephropathy in patients with type 2 diabetes as microangiopathy presentations, but no rigorous study has been conducted to confirm this association. Objectives This study investigated association of diabetic dermopathy with nephropathy and retinopathy in patients with type 2 diabetes referring specialty clinic of Shahrekord. Patients and Methods This descriptive, cross-sectional study was conducted on 102 type 2 diabetes patients with dermopathy referring clinic constantly or as outpatient. Dermatological and ophthalmological examinations and examination for nephropathy were done for all patients. Demographic data and results of examinations and patients history, and biochemical tests were gathered and recorded by researcher developed checklists. Results Mean age of patients was 83.8 2.60 years, of whom 64 (63.7%) were female and 37.3% were male. Prevalence of retinopathy in patients was 4.31% and nephropathy 3.33%. In this study, significant associations of diabetic dermopathy with diabetic nephropathy (P = 0.001), with retinopathy (P < 0.001), age (P < 0.001), duration of diabetes (P = 0.001), and also with glycosylated hemoglobin (P < 0.01) was detected. No significant association between diabetic dermopathy and other studied variables was seen (P > 0.05). Conclusions Results of this study confirm the association of diabetic dermopathy with retinopathy and nephropathy in patients with type 2 diabetes. Since dermopathy is usually developed before retinopathy and nephropathy, dermopathy could be used as a clinical finding in early diagnosis and prevention of retinopathy and nephropathy in diabetes patients.

Concurrent diabetic nephropathy and C1q nephropathy in a young male patient: The first report in literature.

BACKGROUND C1q nephropathy (C1qN) is an uncommon glomerulopathy with a significant deposition of C1q in mesangium without clinical evidence of lupus.According to the best of our knowledge, there is not any report on coincidence of diabetes mellitus and C1qN. CASE PRESENTATION In this report, we presented a 28 years-old-patient with type 1 diabetes and nephrotic range proteinuria, glomerular hematuria and C1q glomerulopathy in renal biopsy. CONCLUSIONS According to the best of our knowledge, there is no previous report about the association between type 1 DM and C1qN. Prevalence of autoimmune disease is higher in type 1 DM and this may explain the relation between DM and C1qN in our patient.

Impact of vitamin D therapy on decreasing of proteinuria in type 2 diabetic patients

Background Vitamin D (Vit D) deficiency is a common disorder in diabetic patients and may be a risk factor for ischemic heart disease and exacerbation of diabetic nephropathy(DN). Objectives The aim of this study was to evaluate the effect of Vit D3 therapy on protein uriain type 2 diabetic patients with deficient or insufficient serum Vit D. Patients and Methods In a double blind clinical trial, 60 type 2 diabetic patients with proteinuria greater than 150 mg/day who had Vit D deficiency or insufficiency were randomly enrolled in two equal groups. Pearl of Vit D as 50 000 IU/week and placebo (1 tablet per week) were prescribed in patients of case and control groups respectively for 8 weeks. At the beginning and 2 months later, 24 hours urine protein was checked in all patients. Results There is no difference between serums Vit D level in case and control group at the beginning of the study, however at the end of the study serum Vit D level was significantly higher in the case group. There is no difference in proteinuria between case and control group at the beginning and the end of the study, while a significant difference between the changes of proteinuria before and after the study was seen in two groups (P = 0.028). Conclusions Vit D deficiency may exacerbate protein uric and DN, hence correction of Vit D deficiency may decrease proteinuria in diabetic patients with nephropathy.

Serum ferritin has correlation with HbA1c in type 2 diabetic patients

Background: Serum C-reactive protein (CRP) and ferritin are two acute phase reactants. CRP may be related to metabolic syndrome and ferritin which in turn could cause resistance to insulin and dysfunction of b cells of pancreases. The aim of the study was the evaluation of the relationship of these two acute phase reactants with some indices of diabetic control. Materials and Methods: In a quasi-experimental study, 67 patients with type 2 diabetes, serum CRP, ferritin, Fasting Blood Sugar (FBS), post prandial BS, Hemoglobin A1c (HbA1c), triglyceride, Low Density Lipoprotein Cholesterol (LDL) and High Density Lipoprotein cholesterol (HDL) were checked before and 3 months after the control of hyperglycemia and hyperlipidemia. Results: The mean age of the patients was 56.5 ± 9.7 (30 to 82) years. There was no significant difference between CRP before and after study; however, serum ferritin significantly decreased after study with control of hyperglycemia. FBS, 2 hours post-prandial blood sugar (2hppBS), HbA1c and triglyceride of patients decreased significantly after control of hyperglycemia and hyperlipidemia (P < 0.05); however, HDL and LDL cholesterol didn′t change (P > 0.05). Conclusion: Based on our results, serum ferritin decreased after decline of patients′ blood sugar, so might be we used it as one of the diabetes control indices for diabetic patients.

Effect of licorice versus bismuth on eradication of Helicobacter pylori in patients with peptic ulcer disease

Background: Different therapeutic regimens were used for eradication of Helicobacter pylori, based on the cost, effectiveness and patients compliance. The aim of this study was the evaluation of licorice compared with bismuth in quadruple regimen on eradication of H. pylori in patients with peptic ulcer disease (PUD). Materials and Methods: In a double-blind clinical trial study, 60 patients with PUD and positive rapid urease test were enrolled. The patients were randomly allocated into two equal groups. In first group, licorice, amoxicillin, metronidazole and omeprazole and in the second (control) group, bismuth subsalicylate, amoxicillin, metronidazole and omeprazole were prescribed respectively, and 4 weeks after treatment, in order to evaluate H. pylori eradication, urea breath test was done in all patients. The outcome of the study was the preference usage of licorice as an effective medication for H. pylori eradication. Results: Mean age of the patients in the control and case groups were 40.8 ± 15.5 and 42.2 ± 15.8 years, respectively (P = 0.726). Seventeen (56.7%) patients in control group and 16 (53.3%) in the case group were female (P = 0.795). Both groups were similar based on frequency of gastric or duodenal ulcer. Response to treatment were seen in 20 (67%) and 17 (57%) patients of case and control groups, respectively (P > 0.05). Conclusion: Our study showed that licorice is as effective as bismuth in H. pylori eradication; therefore, in patients whom bismuth is contraindicated, licorice can be used safely instead.

Effect of N-acetyl cysteine in prevention of contrast nephropathy on patients under intravenous pyelography and contrast CT

Background: Contrast nephropathy is a common and often reversible cause of acute renal failure (ARF). About 10% of ARF in admitted patients might be due to it and may also lead to dialysis. Some methods could prevent it such as fluid therapy with half or normal saline, Na bicarbonate, N-acetyl cysteine (NAC), and so on. The aim of this study was to evaluate the efficacy of NAC to prevent contrast nephropathy. Materials and Methods: In a cross-sectional study, 110 patients who were candidate for intravenous pyelography (IVP) or CT scan enrolled in two groups: Case and control. In patients of case group, meglumine compound and in control group, placebo was prescribed before procedure. Before study and after 48 h, blood urea nitrogen (BUN) and creatinine (Cr) was checked, and glomerular filtration rate (GFR) was measured with Cockcroft-Gault formula. Results: There were no difference between age and gender of two groups. There was also no significant difference between mean Cr before and after study; however, GFR of patients in case group was significantly higher than the control group after 48 h of procedure. Conclusion: Because GFR was higher in case group and there were no drug side-effects in patients, we recommend the use of NAC before administration of intravenous contrast especially in high-risk population such as diabetic patients.

Effect of pioglitazone on decreasing of proteinuria in type 2 diabetic patients with nephropathy

INTRODUCTION Diabetic nephropathy that means albuminuria greater than 30 mg/day, affects about one third of diabetic patients. There are many studies about the effect of different medications for diabetic nephropathy with controversy in their results. So, the aim of the study was to investigate the effect of pioglitazone on decreasing of proteinuria in type II diabetic patients and nephropathy. METHODS AND MATERIALS It is a double blind clinical trial. At first, 2356 medical carts of the patients were evaluated and 76 patients with type 2 diabetes mellitus with proteinuria greater than 250 mg / day were enrolled in 2 equal groups. In the case group, pioglitazone 15 mg/day was prescribed and patients in the control group received placebo for two months. At the beginning of the study and after 2 months, urinary protein during 24 h was measured in all of the patients and data were entered to SPSS (version23) and evaluated by using Chi- square, Mc Nemar, paired t-test and logistic regression model. RESULTS At the beginning of the study, urine protein during 24 h in the case and control groups were 957.7 ± 385.1 and 972.1 ± 378.6 respectively (P = .872). So, after 2 months the mean proteinuria in the case and control groups were 647.3 ± 367.2 and 896 ± 372.4 respectively that is valuable (P = 0.005). Pioglitazone had the considerable effect on FBS,HbA1c and blood triglyceride too. CONCLUSION The study showed that low dose of pioglitazone is an effective, safe and inexpensive method in reducing of proteinuria in type2 diabetic patients with nephropathy.