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The most important complication in kidney transplant is acute/chronic rejection. In this study, we investigated the factors affecting kidney rejection and transplant survival.In this survival analysis study, 352 patients (mean follow-up of 12.9 ± 4.4 years) who underwent renal biopsy due to increased creatinine level from 2012 to 2016 were identified by glomerular filtration rate level and rejection. Probable factors affecting renal function and survival rate after transplant rejection were assessed. P.05 was considered as significant.Among our study patients, 40.9% developed early and 59.1% developed late acute kidney injury. Graft survival rates at 1 and 5 years were 98.9% and 68.5%, respectively, which was significant when rejection type was considered (P = .002). In addition, patient survival rates at 1 and 5 years were 99.7% and 98.6%, respectively. Graft survival at 5 years was significantly lower among older subjects, those with diabetes, those who received deceased donor organs, and those with late acute kidney injury (P.002). Patient survival was significantly higher among young patients, those with systemic lupus erythematosus, those who received living donor organs, and those without cytomegalovirus infection (P.003).We observed that recipient age, type of donor, underlying disease, infection, and late acute kidney injury had great negative impacts on renal dysfunction and survival. In our center, because of the large number of kidney transplants from deceased donors, the necessity of antithymocyte globulin induction therapy was considered, since this study showed that patients who received rabbit antithymocyte globulin induction had better outcomes.

Objective. J point and coved ST elevation in right precordial leads (not produced by coronary artery disease) are still a matter of challenge, especially when resembling Brugada patients. This clinical entity, among asymptomatic individuals with no family history of sudden cardiac death, would be reported in some severely ill patients before ventricular fibrillation. This study investigated the relationship between the electrocardiograms with demographic and laboratory data and also analyzed their association with mortality rate among patients with methanol poisoning. Methods. The sample consisted of 356 patients who were hospitalized with a diagnosis of methanol poisoning in Faghihi and Namazi Hospitals in Shiraz, Southern Iran, in March and April 2020. In this period, a major outbreak of methanol poisoning had occurred in this area. Furthermore, the study used the data on any recorded complications or mortality during hospital course. Results. The ECG (BrP) was observed in a total of 20 (5.6%) patients. Its presence was associated with increased mortality, Glasgow coma scale score P<0.05). Conclusions. This study found that certain ECG patterns and laboratory data can be used as prognostic factors of morbidity and mortality in patients with methanol intoxication. Electrocardiography machines are widely available tools, which can be easily used for risk stratification based on the presence of Brugada approximating electrocardiograms among patients with methanol intoxication.

INTRODUCTION Oxidative stress is considered as important actor in uremia-associated morbidity and mortality in hemodialysis (HD) patients. We aimed to evaluate the role of vitamin D supplementation on oxidative stress parameters in this group. METHODS This double-blind randomized clinical trial was conducted on HD patients who were randomly allocated into intervention (n = 40) or control groups (n = 38) for 10 weeks. Blood samples were taken before and at the end of the trial to measure serum 25-hydroxyvitamin D (25(OH)D), malondialdehyde (MDA), glutathione peroxidase (GPx), catalase (CAT), and superoxide dismutase (SOD). Data were analyzed using SPSS, and P value

Objectives: The high prevalence of diabetes leads to an increase in diabetic complications, and diabetic nephropathy as one them is a leading cause of end stage renal disease and renal replacement therapies. Individual studies on the prevalence diabetic nephropathy in Eastern Mediterranean region (EMR) showed the high prevalence of diabetic nephropathy. Therefore, we conducted a systematic review and meta-analysis of relevant studies to estimate nephropathy among type two diabetes patients in EMR. Method: We searched for the relevant keywords in title and abstract of Medline/PubMed, Scopus, Embase, and Web of knowledge, as well as Google Scholar and manual search to identify the published target studies from Jan 1st, 2000 to December 13, 2020. The two-step screening was carried out by two independent researchers and relevant data were extracted. Estimation of summary proportions, subgroup analysis, meta-regressions, and publication bias assessment were performed.Results: Amongst 3225 identified citations, 38 articles were entered into meta-analysis, involving 112,235 patients. We found that the prevalence of nephropathy in type two diabetes was 26.34% (95% confidence interval (CI)= 21.04%, 32%). Prevalence of nephropathy was 30.42% (95% CI= 23.38%, 37.94%) in males 22.1% (95% CI= 16.05%, 28.79%) in females. Low HDI countries and very high HDI countries had the lowest (21.17% (95% CI= 1.1%, 56.22%)) and the highest (30.93% (95% CI= 22.16%, 40.44%)) prevalence rates. The meta-regression analysis showed that HDI, publication year, mean duration of diabetes, mean age, and diagnostic test were not significant moderators (p = .3323, .7247, .2802, .2199, and .4680, respectively).Conclusions: We estimated a high prevalence of diabetic nephropathy in EMR. Our results implicate the importance of diabetes screening, on time and periodic examinations for nephropathy, diabetes care, and risk factor controls. Large-scale longitudinal studies should be conducted in EMR.

OBJECTIVES The rates of tuberculosis and its mortality are higher in solid-organ transplant recipients than in the general population. In this study, we compared the rate of active tuberculosis disease conversion in solid organ transplant recipients based on pretransplant tuberculin skin test results and also its association with treatment. MATERIALS AND METHODS This cross-sectional study included kidney/liver transplant recipients who had pretransplant tuberculin skin test indurations of ≥5 mm and who were seen from March 2009 to March 2019 at the Shiraz Nemazi Hospital Transplant Center (Shiraz, Iran). Data were analyzed using SPSS software, and P < .05 was considered significant. RESULTS Of 6289 solid-organ transplant recipients seen at our center over the 10-year period, 334 recipients (mean age of 46.0 ± 13.8 years; 67.6% men) had tuberculin skin test indurations of ≥5 mm. Of these 334 recipients, 76.3% had kidney transplant, and the remainder had liver transplant. Of patients who received complete treatment for latent tuberculosis, the rate of conversion to active tuberculosis was lower than in those who did not adhere to medication (8.6% vs 43.7%; P < .001). In addition, the rate of active tuberculosis development was higher in patients who had pretransplant tuberculin skin tests results of ≥10 mm compared with those who had results of 5 to 9 mm (15.8% vs 3.4%; P < .001). CONCLUSIONS Latent tuberculosis diagnosis and treatment before solid-organ transplant can reduce active tuberculosis conversion and its associated morbidity and mortality. We recommend modifying the cutoff point considered for tuberculin skin test positivity for solid-organ transplant candidates in Iran to ≥10 mm, although further evaluations are needed.

Upper gastrointestinal (GI) abnormality is believed to be higher in patients with end-stage renal disease (ESRD) which can make a big trouble for whom undergo kidney transplant. We conducted this study to assess upper GI findings of patients with ESRD. In the present retrospective study we recorded upper GI endoscopy results in hemodialysis patients who were candidate for renal transplantation during a 10-year period. We reviewed files of 1256 patients with a mean age of 37.6 ± 13.4 years. Half of patients (50.6%) had an abnormal endoscopy. Two most common abnormalities were mild gastritis (35.6%) and gastro-esophageal reflux disease (16.7%). GI ulcers were observed in 11% of patients. Duodenal ulcer was the most common ulcer which was seen in 6.8% of patients. Helicobacter pylori was positive in 32.9% of patients and correlated with GI lesions (P = 0.000, r = 0.371). Longer dialysis duration and older patients revealed more upper GI abnormality (P = 0 .032

AIM This study aimed to investigate the impact of social and clinical factors on the diagnostic delay of chronic kidney disease (CKD) among Iranian patients. MATERIALS AND METHODS Our study was conducted on 350 CKD patients who were referred to Faghihi and Motahari clinics (the two largest kidney diseases referral centers in Shiraz the capital of Fars province). Data were collected via an interviewer-administered questionnaire. A multiple linear regression model was used to measure the effect of factors affecting the delay of CKD diagnosis. RESULTS The medians and Interquartile ranges (IQR) of all delays, patient delay, and doctor delay were 6.5 (0-12.2), 5.1 (0-11.2), and 0.9 (0-3.1) months, respectively. The results showed that women were diagnosed 1.61 months earlier than men (p

Background: Binge alcohol eating especially in underdeveloped countries may be complicated by methanol toxicity, especially when blinded drunken cases come to emergency department. Unfortunately, in early months of 2020, Fars, one of the largest provinces in southern Iran, reported one of the largest methanol poisoning outbreaks with high case-fatality rate. Here we like to share our experience and introduce some simple measures which may announce more urgent dialysis to save the lives of these patients.Method: In this study, 356 cases with methanol toxicity referred to the Tertiary Hospitals (Faghihi and Namazi) affiliated to Shiraz University of Medical Sciences during March and April, 2020. To collect the required data, clinical findings on blindness and impaired level of consciousness, laboratory data such as arterial blood gas, electrolytes, and creatinine, and the most common findings from ECGs were collected. Results: Among the participants, 321 (90.2%) patients were male, and 162 persons (45.5%) were aged below 30 years old. Reviewing the laboratory data of the included patients revealed that PH, HCO3, and O2 saturation decreased. While PCO2, Cr, K, BS increased (P=70, Brugada pattern, low voltage QRS, severe metabolic acidosis (PHConclusion: Apart from usual modalities like acidosis, electrolyte imbalance, QTc prolongation and prominent U wave, we found Brugada like ECG, notch in QRS and steeply terminal T wave more than 70 degrees to be ominous signs and need urgent attention.

Introduction: Brugada phenocopies are recently introduced as clinical entities with electrocardiographic patterns identical to true congenital Brugada syndrome in individuals, who are asymptomatic and have no other clinical criteria. One of the largest methanol poisoning outbreaks occurred in Iran during March and April 2020. This study aimed to investigate the relationship between Brugada Phenocopy with laboratory data and demographic factors and determine its association with mortality rate in methanol toxicity patients. Method and results: Demographic data such as age, gender, medical history, Glasgow coma scale score, laboratory data, and electrocardiographic data were obtained from 356 patients, who were diagnosed with methanol poisoning and were hospitalized in Faghihi and Namazi Hospitals in Shiraz, southern Iran, during March and April 2020. The follow-up data was gathered to examine the development of any complications or death. A total of 20 (5.6%) patients were admitted with a diagnosis of methanol toxicity and concurrent Brugada-like ECG patterns. Mortality rate, Glasgow Coma Scale Score

Background Methanol is widely used in industry; however, methanol poisoning is not common. In this regard, a number of outbreaks have been recently reported due to inappropriate processing of alcoholic beverages. Shiraz, a city located in the southern part of Iran, faced one of such outbreaks in 2020 during COVID-19 pandemic. There is no sufficient literature on the electrocardiographic findings in methanol toxicity. This study aimed to address this gap in the literature. Method A total of 356 cases with methanol toxicity referred to Shiraz University of Medical Science Tertiary Hospitals (Faghihi and Namazi) in March and April, 2020. The clinical findings of blindness and impaired level of consciousness, lab data such as arterial blood gas, electrolytes, and creatinine, and the most common findings from ECGs were collected. Results The most common ECG findings were J point elevation (68.8%), presence of U wave (59.2%), QTc prolongation (53.2% in males and 28.6% in females), and fragmented QRS (33.7%). An outstanding finding in this study was the presence of myocardial infarction in 5.3% of the cases. This finding, to the best of our knowledge, has only been reported in a few case reports. Brugada pattern (8.1%) and Osborn wave (3.7%) were the other interesting findings. In multivariate analysis, when confounding factors were adjusted, myocardial infarction, atrioventricular conduction disturbances, sinus tachycardia, and the prolonged QTC > 500 msecond were four independent factors correlated with methanol toxicity severity measured with arterial blood PH on arterial blood gas measurements, with odds ratios of 12.82, 4.46, 2.32 and 3.15 (P Conclusion Electrocardiographic variations during methanol intoxication are remarkable and well-correlated with poisoning severity. Myocardial infarction was an egregious and yet a common concerning finding in this sample, which need to be ruled out in methanol toxicity.

Background: Nephrolithiasis is a worldwide health problem. Objectives This study investigated the frequency of urinary and serum metabolic abnormalities and their association with demographic characteristics in patients with nephrolithiasis. Methods: In this cross-sectional study, we assessed 376 patients with nephrolithiasis who referred to Motahari Medical Center, Shiraz from March 2017 to June 2017. Patients’ history, 24-hour urine analysis (for volume, calcium, uric acid, sodium, citrate, phosphate, and oxalate), and serum tests (for calcium, uric acid, and parathyroid hormone) were recorded in a data gathering sheet. P value < 0.05 was considered statistically significant. Results: The most common abnormality was a low volume of 24-hour urine (< 2000 mL), (73.7%), followed by hypercalciuria (23.9%), and hyperoxaluria (19.4%). Low 24-hour urine volume was more frequent in women (80.0% vs. 64.3%, P < 0.001), while hypercalciuria (37.0% vs. 18.3%, P < 0.001), and hyperphosphaturia (6.0% vs. 1.7%, P = 0.03) were more frequent in men. Moreover, hypercalciuria was more frequent in outdoor workers (39.7% vs. 21.1%, P = 0.003), whereas low urine volume was more frequent in indoor workers (79.0% vs. 61.1%, P = 0.006). Metabolic abnormalities were not different in terms of patients’ family history. Conclusions: Multiple factors affect the frequency and type of nephrolithiasis. Since these parameters are also influenced by race, culture, and dietary habits; thus each region must determine its own demographic features of renal stone. Based on our results, women had lower urine volume and higher urine citrate than men. Moreover, water intake is one of the most important factors that correlate with renal stone formation.

Introduction: Uremic pruritus is an undesirable complication of end stage renal disease (ESRD). In spite of introduction of many treatments for this complication, it has no certain cure. The aim of this study was to assess sertraline effect on uremic pruritus. Methods: In the present clinical trial study, we randomly divided our patients into two groups; trial group that received sertraline and control group that consumed placebo. We measured the severity of pruritus by two scoring systems (visual analogue scale and DUO) at the beginning and during the study with a-2-week interval. Data were analyzed by SPSS 18.0 and a P value

No large study has been conducted on biopsy-proven nephropathies. Our aim was to report clinical and pathological pattern of kidney disease diagnosed by kidney biopsy in our center. This is a retrospective study on kidney biopsy during 7 years; we analyzed the results of kidney biopsies and their clinical data. Data were analyzed by SPSS 18.0 and a P.05 was considered. In 1355 kidney biopsies (55.7% women, age = 33.2 ± 16.4), primary glomerulonephritis (GN) was the main feature (57.1%). The most common presentation was asymptomatic urine abnormality (32.3%). Lupus nephritis (24.5%), membranous GN (17.0%), and focal segmental glomerulosclerosis (13.9%) were the most frequent diagnosis. This study highlights the histopathological patterns of kidney disease in southern Iran. lupus nephritis, membranous GN, and focal segmental glomerulosclerosis are currently the three major diseases. These results have an important role in organizing renal health plans as an initial phase in our population.

Introduction: End stage renal disease (ESRD) reasons several changes in the function of thyroid gland as; lower levels of thyroid hormones, altered hormone metabolism, and increased iodine storage. The aim of this study was to evaluate the prevalence of nodular goiter and hypothyroidism in hemodialysis (HD) patients compared with normal population. Methods: This cross-sectional study was conducted among HD patients and healthy people as the control group for thyroid function evaluation. Thyroid gland was evaluated by physical examination and ultrasonography. Blood level of FT3, FT4, TSH, TPO Ab, and urinary iodine excretion were checked in both groups. Data were analyzed using SPSS-17 and P-value less than 0.05 was considered as the significance level. Findings: Eighty six HD patients (57.2 ± 17.2 mean age, 48 men) and 86 healthy people (56.6 ± 16.8 mean age, 48 men) were enrolled in this study. Goiter was confirmed by physical examination in 29.0% of the HD patients and 12.8% of the control group (P = 0.04). Nodular goiter that was shown by ultrasonography was found in 27.9% and 3.5% of the HD and control groups, respectively (P = 0.01). HD patients had a higher frequency of reduced FT3 (40.9% vs. 4.6%, P

Background: Today, one of the most serious problems of hemodialysis patients is poor nutrition, significantly affected by inadequate dialysis. Not only it is necessary to have sufficient knowledge in this area, but it is also important to find more effective educational methods in this regard. With this background in mind, this study aimed to evaluate the effect of integrated trainings on nutritional status and dialysis adequacy in hemodialysis patients. Methods: This clinical trial was conducted on hemodialysis patients, referred to one of the hospitals of Shiraz, Iran in 2015. In total, 56 patients were selected through randomized convenience sampling and divided into two groups of intervention and control. Integrated trainings was provided for the participants of intervention group in the form of five group and individual sessions of 10-30 minutes during hemodialysis. The nutritional status and dialysis adequacy of all the participants were evaluated before, one month and two months after the intervention in the dialysis ward based on subjective global assessment and KT/V, respectively. Data analysis was performed in SPSS version 21 using Fisher’s exact test, independent t-test, repeated measures ANOVA, Chi-square and Cochran test. Results: In this study, the nutritional status of the participants was significantly improved one and two months after the intervention (P

IntroductionLupus nephritis (LN) is one of the most common complications of systemic lupus erythematous (SLE) responsible for an increase in mortality and morbidity. This study was conducted to evaluate the outcome for LN patients and factors that correlate with their outcome.Materials and methodsWe included 80 patients with proved LN and more than three-years follow up at Shiraz University of Medical Sciences. We prepared a data gathering sheet for each patient and extracted the data from patients’ file records which existed in the hospital.ResultsThe mean age of patients was 36.6 ± 10.6 years, and 88.3% of patients were women. Men develop remission less than women (three men (33.3%) vs 49 women (72.1%), p = 0.014). Chronic kidney disease (GFR ConclusionThere is a strong agreement among studies that initial Cr, hypertension and lack of remission are associated with poor outcome in LN patients. As a result we must observe hypertensive patients and patients with increased Cr more carefully. Also, we should consider changing treatment in patients who do not develop remission. In spite of dominancy of women in SLE, men are likely to have poorer outcomes.

Uremic pruritus is one of the most common disabling symptoms in patients with end-stage renal disease. We aimed to study the effect of montelukast sodium for the treatment of uremic pruritus lasting more than 3 months in patients undergoing hemodialysis and compare it with placebo.Eighty patients undergoing hemodialysis at 3 centers in Shiraz, Iran, were recruited to a randomized double-blinded controlled trial to receive 10 mg of montelukast or placebo, daily for 30 days. To assess the severity of pruritus, a visual analogue scale and the Detailed Pruritus Score, based on a combined score of severity and distribution of pruritus and sleep disturbance, were used. Sleep disturbance, severity, and distribution scores were added up to calculate the patients' final score at the start and the end of the study.The mean reduction of visual analogue scale score was significantly greater in the montelukast group (2.73 ± 2.03) compared to that in the placebo group (5.47 ± 2.37, P.001). Mean reduction in Detailed Pruritus Score was also greater in the montelukast group (3.24 ± 2.2 versus 6.44 ± 3.25, respectively, P.001). The mean high-sensitivity C-reactive protein in the montelukast group decreased from 5.48 ± 3.86 µg/mL to 3.86 ± 3.58 µg/mL, while it increased in the placebo group from 6.69 ± 4.49 µg/mL to 8.14 ± 5.20 µg/mL.Montelukast can be an add-on therapy in uremic pruritus, especially when pruritus is refractive to other treatments.

End stage renal disease (ESRD) reasons several changes in the function of thyroid gland as; lower levels of thyroid hormones, altered hormone metabolism, and increased iodine storage. The aim of this study was to evaluate the prevalence of nodular goiter and hypothyroidism in hemodialysis (HD) patients compared with normal population.This cross-sectional study was conducted among HD patients and healthy people as the control group for thyroid function evaluation. Thyroid gland was evaluated by physical examination and ultrasonography. Blood level of FT3, FT4, TSH, TPO Ab, and urinary iodine excretion were checked in both groups. Data were analyzed using SPSS-17 and P-value less than 0.05 was considered as the significance level.Eighty six HD patients (57.2 ± 17.2 mean age, 48 men) and 86 healthy people (56.6 ± 16.8 mean age, 48 men) were enrolled in this study. Goiter was confirmed by physical examination in 29.0% of the HD patients and 12.8% of the control group (P = 0.04). Nodular goiter that was shown by ultrasonography was found in 27.9% and 3.5% of the HD and control groups, respectively (P = 0.01). HD patients had a higher frequency of reduced FT3 (40.9% vs. 4.6%, P 0.01) and increased TSH (18.6% vs. 8.1%, P 0.03(. TPO Ab was positive in 15.1% of the HD and 11.6% of the control groups (P = 0.14).The high incidence of nodular goiter and hypothyroidism in ESRD patients shows that screening for thyroid dysfunction and goiter, using appropriate laboratory tests, should be considered in evaluations of ESRD patients.

Till now many treatments attempted to relieve uremic pruritus (UP) though none of them are definite treatment. In this study, we gathered all studies conducted on UP treatment since 2000-2016. We conducted a systematic review by searching the electronic databases (PubMed, Scopus, and Google scholar). Patients were with chronic kidney disease who complained of UP. Clinical trials and pilot studies in English and Persian which were done on patients with ESRD who complained of itching between 2000 till 2016 were gathered. A total of 166 articles were collected. After excluding articles 41 articles were remaining. Then UP treatments classified into two main groups: Medical (chemical and herbal medicine) and non-medical. Most studies measured UP by VAS scoring system in which patients described the severity. This scoring system is individual dependent. There are lots of studies on UP treatment though there are lots of controversies in studies. Finding a definite cure for this unpleasant symptom can improve patients' quality of life. Conducting further studies for each treatment on larger population is essential to improve quality of life among the end stage renal disease patients.

Uremic pruritus is a difficult symptom in chronic hemodialysis (HD) patients, and its patho-physiological mechanism remains unknown. To determine the relationship between pruritus and C-reactive protein as well as dialysis adequacy among the HD patients, we studied 241 chronic HD patients in Shiraz dialysis centers, Iran. The patients were selected by convenient sampling and the data were collected using a checklist, interview and lab tests. The mean age of our patients was 53.9 ± 16.3 years and 128 (53.1%) of them were male. There were 97 (40.2%) patients who complained of pruritus. A significant association was found between high-sensitive C-reactive protein and pruritus (P = 0.004). Also, a significant positive relationship was observed between pruritus and dialysis adequacy (P

Chronic kidney disease (CKD) is a public health problem and it is suggested that low socioeconomic status (SES) may increase the risk of renal failure. The aim of this study was to report and compare the SES of hemodialysis patients (HD) and normal population in Shiraz, Iran. In this cross-sectional study, we evaluated 519 HD patients and 900 normal controls. We asked about SES using a questionnaire. The participants were categorized into three groups according to their SES as low, medium, and high SES. Of the 1419 participants, 454 (31.7%), 581 (40.6%), and 395 (27.6%) were grouped in low, medium, and high SES, respectively. Most of our normal controls (43.5%) were in the medium SES group and most of the HD patients (61.3%) were in the low SES group. HD patients had a significantly lower SES score than the normal population (P