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Clinical Case Reports

Severe hyponatremia is life‐threatening in hospitalized patients. We present an elderly female wh... more Severe hyponatremia is life‐threatening in hospitalized patients. We present an elderly female who developed severe hyponatremia, seizure, and loss of consciousness after taking polyethylene glycol (PEG) solution before colonoscopy. The risk of hyponatremia with PEG for colon preparation in elderly susceptible patients is high. We review the relevant literature.

Objectives: The most important renal complication of systemic sclerosis (SSc) is scleroderma rena... more Objectives: The most important renal complication of systemic sclerosis (SSc) is scleroderma renal crisis (SRC). Many patients demonstrate less severe renal complications, most likely associated with reduced renal blood flow and a consequent reduction in glomerular filtration rate (GFR). The mechanism of this slowly progressive form of chronic renal disease is unclear. The aim of this study was to evaluate GFR by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and the 7-variable Modification of Diet and Renal Disease (MDRD) equations in SSc patients and to correlate estimated GFR (eGFR) with clinical variables of the disease. Methods: 105 unselected and consecutive patients with SSc were enrolled. Serum creatinine was measured in all patients and GFR was estimated by 7-variable MDRD and CKD-EPI equations. Nailfold videocapillaroscopy was performed in all patients. Results: The mean value of eGFR evaluated by both 7-variable MDRD and CKD-EPI was significantly different (p < 0.0001) in the three capillaroscopic groups and correlated negatively with the severity of capillaroscopic damage (early: 95 ± 16 mL/min and 101 ± 12 mL/min, active: 86 ± 25 mL/min and 95 ± 17 mL/min, late: 76 ± 21 mL/min and 82 ± 21 mL/min). The mean value of eGFR evaluated by 7-variable MDRD (97 ± 23 mL/min vs. 74 ± 15 mL/min, p < 0.0001) and CKD-EPI (0.83 ± 0.20 mL/min vs. 0.68 ± 0.10 mL/min, p < 0.0001) was significantly higher in SSc patients without history of digital ulcers than in those with. Conclusion: We can conclude that in SSc patients without renal involvement, eGFR decreases with the progression of digital vascular damage.

DOAJ (DOAJ: Directory of Open Access Journals), May 1, 2020

Journal of research in pharmacy practice, 2022

Journal of Research in Medical Sciences, 2006

Journal of research in pharmacy practice, 2021

Journal of Research in Medical Sciences, Jan 28, 2005

Background: Angiotensin converting enzyme inhibitors (ACEIs) are known to induce anemia following... more Background: Angiotensin converting enzyme inhibitors (ACEIs) are known to induce anemia following renal transplantation, dialysis and in renal failure patients. It seems that ACEIs cause anemia via inhibition of erythropoietin synthesis or inhibiting normal proliferation of early erythroid progenitors, which are normally stimulated by angiotensin converting enzyme. There are few reports on how ACEIs induce anemia in non-azotemic diabetic patients. We studied the effect of enalapril on inducing anemia in non-azotemic diabetic patients. Methods: This study included 94 diabetic non-azotemic patients (serum creatinine (sCr) ≤1.5 mg/dl by jaffe reaction). Patients were divided into two groups, the first; with clinical proteinuria (P+) having a 24 hour urine protein ≥300 mg or positive urine dipstick for protein, at least on two of three times tested, with an interval of 1 month and the second group without any signs of clinical proteinuria (P-). Only 32 patients completed the course of study; 17 as P+ and 15 as P-. Patients in both groups received 10 mg enalapril daily; and every 3 months, the dose was doubled until the dose of 40 mg/day was reached, unless any side effects emerged. Hemoglobin concentration (Hb), sCr and serum potassium (K +) were also checked regularly. Data were analyzed using t-Student test, paired t test, and chi-square test. A p value < 0.05 was considered as significant. Results: Both groups of patients were matched from the standpoint of age and sex. The average baseline sCr in P+ and Pgroups were 0.8 ± 0.19 mg/dl and 0.8 ± 0.18 mg/dl respectively.(p = 0.97) After the study was completed, the average baseline sCr rose to 0.99±0.19 and 0.92±0.22 mg/dl in P+ and P-groups respectively. (p=0.32) In P+ group, mean Hb was 14.1 ±1.30 g/dl and 13.9 ± 0.99g/dl before and after the study respectively.(p = 0.28) The same parameter for the P-group was measured as 14.1±1.00 and 12.9±3.30 before and after the study respectively.(p=0.16) Conclusion: This study shows that enalapril has no significant effect on inducing anemia in non-azotemic diabetic patients.

Journal of Isfahan Medical School, Apr 1, 2017

Journal of Renal and Hepatic Disorders, Mar 1, 2023

In recent years, interest in Health-Related Quality of Life (HRQoL) as a major indicator of clini... more In recent years, interest in Health-Related Quality of Life (HRQoL) as a major indicator of clinical efficacy and treatment outcome in patients of End-Stage Renal Disease (ESRD) has grown significantly. This study aimed to determine the contributing factors affecting the quality of life (QoL) of ESRD patients undergoing peritoneal dialysis (PD). A cross-sectional study was conducted on PD patients presented at PD centres of Al-Zahra and Noor hospitals in Isfahan, Iran, from May to August 2019. A total of 173 patients having peritoneal dialysis for more than 3 months filled the validated 36-item short-form health survey questionnaire (SF-36). Baseline demographic details and dialysis-related factors were collected from patients' medical records. The overall QoL score of patients was 50.28 ± 20.87. Male patients had a higher QoL score than female patients (58.18 in males, compared to 48.18 in females; P = 0.04). A significant association between frequency of dialysis and quality of life was observed, where three sessions of dialysis per day yielded the highest quality of life (QoL score = 59.62; P = 0.047). A significant positive correlation was discovered between QoL score and residual renal function (P = 0.013). In addition, a higher QoL score was observed in self-employed patients (60.95), compared to housewives (46.49) (P = 0.001). QoL assessment should be included as an integral part of patient follow-up to evaluate treatment outcomes and implement possible interventions to improve patient's quality of life.

PubMed, Sep 1, 2022

The pandemic of COVID-19 emerged in December 2019. Although numerous features of the illness have... more The pandemic of COVID-19 emerged in December 2019. Although numerous features of the illness have been investigated, the impact of disease on those patients with underlying diseases, is still a major problem. The aim of this multicenter, cohort study, was to determine the clinical manifestations of COVID-19 in peritoneal dialysis (PD) patients. Five hundred and five patients, receiving PD, were enrolled in this study, out of which 3.7% had coronavirus infection. Fever was the most common symptom (63.2%). The hospitalization rate was 10.5, 21.1% required admission to intensive care units (ICU) and the mortality rate was 21%. The most common cause of infection included close contact with the infected individuals and lower rates of protective equipment use. Although the incidence of COVID-19 among PD patients is low, the severity of the disease and the mortality rate are quite high. Vaccination and adherence to preventive measures are strongly recommended in PD patients. DOI: 10.52547/ijkd.7147.

PubMed, 2023

Background: Chronic kidney disease (CKD) is an important comorbidity in Coronavirus Disease 2019 ... more Background: Chronic kidney disease (CKD) is an important comorbidity in Coronavirus Disease 2019 (COVID-19) patients considering its high prevalence. We aimed to figure out the relationship between CKD and COVID-19 mortality in this study. Materials and methods: In total, 116 CKD patients (estimated glomerular filtration rate [eGFR] lower than 60 mL/min/1.73 m2) and 147 control subjects confirmed with COVID-19 were studied. Data regarding demographics, sign and symptoms, laboratory findings, and chest computed tomography were collected. Association between CKD and in-hospital mortality were analyzed using logistic regression models adjusted for confounders. Results: Mortality rate was significantly higher in CKD than non-CKD (30.17 vs 4.76, P < 0.001) COVID-19 patients. Multivariate logistic regression showed that CKD was significantly correlated with in-hospital mortality in the total sample (Odds ratio (OR) = 8.64, confidence interval (CI): 3.67-20.35) and gender subgroups (females: OR = 4.77, CI: 1.38-16.40, males: OR = 13.43, CI: 3.85-46.87) (P < 0.05) of COVID-19 patients in the crude model. Whereas, the correlation did not remain significant in the fully adjusted model in the total sample (OR = 1.70, CI: 0.35-8.19) and gender subgroups (females: OR = 1.07 CI: 0.06-19.82, males: OR = 0.87, CI: 0.07-10.33) (P > 0.05) of COVID-19 patients. Conclusion: This study suggested an independent association between CKD and in-hospital mortality in COVID-19 patients. Therefore, more intensive surveillance of COVID-19 patients with CKD is to be warranted.

Journal of Research in Medical Sciences, 2023

Background & aims: Moderate alcohol intake is associated with reduced prevalence or incidence of ... more Background & aims: Moderate alcohol intake is associated with reduced prevalence or incidence of fatty liver. However, whether or not the association is independent of dietary patterns remains unclear. We aimed to evaluate the cross-sectional association of alcohol intake with fatty liver after accounting for dietary patterns and obesity. Methods: We assessed 4579 adults aged 30e79 years who participated in routine clinical examinations in St. Luke's International Hospital, Japan (January to March, 2015). We assessed their habitual diet using diet-history questionnaire, estimated alcohol intake, and derived dietary pattern variables using factor analysis. Fatty liver was ascertained using ultrasonography. Linear and U-shaped associations of alcohol intake with fatty liver were evaluated using Poisson regression, and a post hoc analysis was conducted after detecting potential outliers for alcohol intake and excluding them using sex-specific statistics (median plus 2 Â interquartile range). Results: Fatty liver was ascertained in 1120 participants (24.5%). Whereas no significant association of alcohol intake with fatty liver was observed when potential outliers of alcohol intake were included (p ¼ 0.25), a significant U-shaped association was observed after excluding the outliers with and without adjustment for dietary patterns (p ¼ 0.003 and 0.02, respectively). The lowest prevalence was estimated when alcohol consumption was approximately 7% of energy, with a prevalence ratio of 0.72 (95% confidence interval ¼ 0.59e0.86) compared to non-drinkers. The association became imprecise and attenuated toward the null after further adjustment for body mass index (p ¼ 0.06). Conclusions: Alcohol intake showed a U-shaped association with fatty liver prevalence. This association was independent of underlying dietary patterns, while it was sensitive to excessive alcohol intake and obesity status, providing clinical implications for the prevention of fatty liver.

Kidney International Reports, Feb 1, 2022