Background: The etiology of END STAGE RENAL Disease (ESRD) in every community differs according to genetic, nutrition, and public health status. ESRD, the terminal STAGE of chronic RENAL failure, needs replacement therapy otherwise could lead to death.The aim of the study is to determine the relative frequency of ESRD etiology in hemodialysis patients of Gilan province.Methods: This descriptive study was performed on 407 patients who were being hemodialysisin all hemodialysis centers of the Gilan province from September 2002 to September 2003. The original data was collected from the medical records of patients.Results: The most prevalent causes were: hypertension 35.4%; unknown etiology 16.2%; diabetes mellitus 13.8%, glomerulopathies 9.6%, urologic causes 9.1%, cystic kidney DISEASES 7.6 %; other causes 5.9 %; congenital 2.5%.Conclusion: In our study hypertension was the first etiology of ESRD, followed by unknown causes, however nephrology textbooks indicate diabetes mellitus as the primary and hypertension as the secondary etiology of ESRD.

Background: Chronic RENAL failure defines as progressive and irreversible dysfunction of kidneys that could eventually terminated to END STAGE RENAL disease (GFR<10% NL).Because of therapeutic problem and high mortality and morbidity and it "s implication quality of life , ESRD is one of the important dilemma of pediatric medicine .Materials and Methods: In our study 216 patients evaluated . Results: Male to female ratio was 1.1 . The peak of the presenting age of ESRD was 10 years old (8-12 y). Congenital urological malformation (30%) , glomerulopathies (20%) , hereditary nephropathies (14.3%) , multisystem DISEASES (7%) and nephrolithiasis (6.2%) are the most common etiologies of ESRD . VUR in 21% and congenital obstructive disease in 8.5% are the etiology of ESRD. In patients with age five years old and lesser common causes of ESRD are congenital urologic malformation and glomerulopathies. In other age groups , urologic malformation is the most common cause of ESRD. In etiologic assessment of two separate 7 years interval , (1988-1993) and (1996-2003) , there was not any significant change in frequency of etiologies but frequency of congenital obstructive uropathy decreased from 10 % to 5.7%. Total amount of VUR (VUR ± Neuropathic bladder) has not any change but frequency of primary reflux nephropathy decreased from 14.2% to 8%. In this study , in 145 patients hemodialysis continued and 28 cases had unsuccessful RENAL transplant (13.8%) . 7.4 % of patients had successful RENAL replacement therapy (RRT) and mortality rate was 7.4% . B Conclusion: Based on that the most common cause of ESRD is all ages in congenital urologic malformations , early diagnosis and appropriate management of these cases are effective in decreasing incidence of ESRD and with respect to few cases of RENAL transplant and unsuccessful results in 65% of RRT , the approach of this problem should be revised.

Background: Hyperhomocysteinemia is a risk factor for cardiovascular disease particularly in patients with END STAGE RENAL disease (ESRD). Vitamin B12 supplementation on its own still remains as a controversial issue for clinicians in decreasing the level of homcysteine in this group of patients.Methods: Using all randomized controlled trials (RCTs), clinical trials and pre-post-trial studies found during January 1999 to March 2014, we conducted a systematic review which assessed the effects of vitamin B12 in decreasing homocysteine levels in patients with ESRD.Results: The findings of this study revealed that, overall, the greatest effect of B12 supplementation on decreasing homocysteine levels in patients with ESRDs occurred when it was combined with folate supplementation.It was also demonstrated that injection treatments might be more beneficial than oral intake treatments.Conclusion: More rigorous studies are needed to draw a firm conclusion about B12 therapy and the level of homocyteine in patients with ESRD.

Background: Dialysis costs was a heavy burden in END STAGE RENAL Disease (ESRD) patients. In China, the two major medical insurance systems are the New Cooperative Medical Scheme (NCMS) for rural residents and the Urban Employees’ Medical Insurance (UEMI) for urban patients. This study compared the economic bur-den of ESRD patients under different dialysis methods and the impact of the medical insurance system on it. Methods: Overall, 156 ESRD patients were enrolled at the Department of Nephrology in the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China between Jan 2013 and Jan 2014. They were divided into hemodialysis group (HD group, n=84) and peritoneal dialysis group (PD group, n=72). The data, such as the patient's basic information, total expenses and self-paid expenses in the early STAGE of dialysis and 1-year treat-ment, and medical insurance type, were separately collected. Results: The early-STAGE average total expenses and self-paid expenses in the PD group were higher than those in the HD group (P<0. 01). The average total expenses and self-paid expenses in the PD group were lower than those in the HD group (P<0. 01). Whichever dialysis method was used, the self-paid expense percentage for the NCMS patients and was higher than UEMI patients. Conclusion: In terms of the long-term dialysis treatment for ESRD patients, the better choice was PD judging by the treatment expenses. Meanwhile, different medical insurance types had significant economic burden im-pacts on dialysis patients.

Dear Editor, Anemia is a common complication of chronic kidney disease (CKD) and can appear before uremic syndrome when the glomerular filtration rate (GFR) decreases to less than 30 mL/min. A low level of hemoglobin (Hb) is an indepENDent risk factor for low quality of life inCKDpatients. Untreated anemia in CKD patients leads to several physiological abnormalities such as impaired heart function, decreased cognation and mental activity, hemostatic dysfunction, impaired immune function and sexual function. Clinical symptoms of anemia include fatigue, depression, concentration problems, loss of appetite, sleep disturbance, shortness of breath and heart palpitations...

Background: The mortality rate of sepsis and pneumonia is higher in END-STAGE RENAL disease (ESRD) patients than in the general population. Bacterial infections are the most common cause of hospitalization in dialysis patients and the most common source of bacteremia is vascular access in these patients. The aim of this study was to determine the prevalence of infectious causes of hospitalization in patients with ENDSTAGE RENAL failure in Gorgan. Methods: This cross-sectional study was performed on patients with ESRD who were admitted to the 5 Azar Medical Education Center of Gorgan City during 2014 to 2016. Patients' information was collected through their clinical records and analyzed statistically. Results: The prevalence of infectious DISEASES in ESRD patients during the 3 years was 12. 7%, out of 100 hospitalized patients with ESRD and infectious causes, the most common type of infectious disease was catheter infection (43%) and sepsis (18%), urinary tract infection (11%) and pneumonia (8%) were the next. The most common infectious causes leading to hospitalization in men with the ESRD were catheter infection, sepsis, and pneumonia, respectively, and in women, catheter infection, sepsis, and urinary tract infection. The highest incidence of catheter infection was in the age group of 66-70 years (30. 2%), 71-75 (25. 6%), and above 71 years (25. 6%), respectively. The highest incidence of sepsis occurred in the age group of 75-71 years (38. 9%) and also the highest incidence of urinary tract infections in the age group of less than 65 years. Age (P=0. 003), sex (P=0. 01), duration of disease (P=0. 009), addiction (P=0. 01), and diabetes (P=0. 01) were the most common risk factors for infectious DISEASES in patients with ESRD. Conclusion: The results of this study showed that catheter infection is the most common cause of infection in patients with END-STAGE RENAL disease (ESRD). Therefore, avoiding multiple vascular manipulations, disinfection of the catheter, timely replacement, and training of dialysis staff are effective in reducing catheter infections.

The presenting pt is a 13 years old girl who developed ESRD due to Bardet - biedl syndrome. She was complaining of sever weakness, lethargy, nausea, vomiting, dyspnea and decreased level of consciousness. Physical examination revealed all sings of this syndrome, which includes polydactyly, pigmented Retinopathy, truncal obesity, mental retardation, underdevelopment of sexual characteristics. In lab, sever anemia, serum creatinin 8mg/d, hyperkalemia and metobolic acidosis revealed. According to above mentioned evidences, and small size kidneys in ultrasonograghy, and also with attention to this point that she is a product of a familial marriage, diagnosis of Bardet - Biedl syndrome is documented.

END-STAGE RENAL disease (ESRD) is a rapidly growing global health problem within the past decades due to increased life expectancy, diabetes mellitus, hypertension, and vascular DISEASES. Since ESRD is not curable definitively, patients suffering from ESRD have a very low quality of life; therefore, symptomatic management is the cornerstone of medical treatment. Uremia affects almost all body organs, such as skin, through different mechanisms including biochemical, vascular, neurologic, immunologic, hematologic, ENDocrine, and electrolyte and volume balance disturbances. Some of these conditions are associated with significant morbidity, and patients with ESRD commonly present with a spectrum of dermatologic disorders. Each one has its own unique presentation and treatment approaches. In this review article, we discuss the clinical presentation, pathophysiology, and treatment of the most common skin disorders associated with ESRD.