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.

Introduction. Hyperhomocysteinemia is common in patients with END-STAGE RENAL DISEASE. It is one of the risk factors for cardiovascular DISEASE. We evaluated the effect of different doses of folic acid on serum homocysteine level in patients on hemodialysis.Materials and Methods. Patients on maintenance hemodialysis were randomized into 4 groups to receive oral folic acid at doses of 2, 5, 10, and 15 mg/d, each for a period of 4 weeks. Serum homocysteine level was measured in all of the patients before and at the end of each week of therapy. Folic acid supplementation was discontinued during a washout period of 1 week between each of the four phases of the trial.Results. Thirty-one hemodialysis patients completed the four phases of treatment with each dose of folic acid (17 women and 14 men). The mean age of patients was 57.6±14.6 years. Serum homocysteine level was reduced significantly compared to its basal level after treatment with folic acid at different doses (P<.001).Different doses of folic acid were not significantly different in lowering serum homocysteine levels.Conclusions. Our study failed to show any difference between high-dose and low-dose folic acid therapy regarding their effect on serum homocysteine level. It seems folic acid, 2 mg/d, is an adequate dose, and there is no need to administer a higher dose of it.

Introduction. C-reactive protein (CRP) is increased among patients on maintenance hemodialysis. Such inflammatory markers can result in protein-energy deficit syndromes and low adequacy of dialysis in these patients. This study evaluated the effect of pentoxifylline on serum CRP level and KT/V in END-STAGE RENAL DISEASE patients on maintenance hemodialysis. Material and Methods. This 1-month randomized, double-blind, placebo-controlled clinical trial involving 73 patients with endstage RENAL DISEASE on maintenance hemodialysis assessed the effectiveness of 400 mg/d of pentoxifylline on serum CRP level decrease and improvement of dialysis adequacy. Results. The difference in mean serum CRP levels of the pentoxifylline and placebo groups was not significant before study. While CRP showed showed a significant increase in the placebo group after completing the interventions (P =. 01), the difference was nonsignificant in the pentoxifylline group (P =. 53). The difference in the mean adequacy of dialysis was not significant before the interventions between the two groups, while there was a significant increase in the pentoxifylline group (P =. 01) and a nonsignificant increase in the placebo group (P =. 31) after the interventions. Conclusions. Among patients on maintenance hemodialysis, a 1-month trial of pentoxifylline was associated with a substantial improvement of adequacy of dialysis and a significant prevention from serum CRP level increase, but not a significant reduction in the mean serum CRP level.

Introduction: END-STAGE RENAL DISEASE has been associated with premature atherosclerosis of the cerebral circulation. The risk of stroke, a frequent complication of uremia as a result of cerebral blood flow reduction, is high in dialysis patients. This study aimed to assess brain hemodynamics between hemodialysis interval periods by transcranial Doppler ultrasonography.Materials and Methods: In a case-control study, to evaluate cerebral circulation homodynamics, 20 hemodialysis patients and 20 agegender-matched healthy control subjects underwent transcranial Doppler ultrasonography. Blood parameters were also measured simultaneously. Among hemodialysis patients, these studies were performed 48 hours after a dialysis session.Results: The mean blood flow velocity (MV) values were significantly higher in the middle cerebral artery (P=0.007), anterior cerebral artery (P=0.003), posterior cerebral artery-segment 2 (P=0.03), basilar artery (P=0.05) in hemodialysis patients compared to the controls.The MV had a negative meaningful correlation with hemoglobin and hematocrit in most intracranial arteries of the patients, but no significant correlation was observed between these variables and MV of the arteries in the control group.Conclusions: The MV of the cerebral arteries significantly increases in hemodialysis patients, which could be due to the decrease in hemoglobin levels in these patients.

Introduction. Recurrence of glomerulonephritis (GN) after kidney transplant (Tx) may be associated with allograft loss. This study aimed to evaluate the frequency and prognosis of de novo or recurrent post-Tx GN. Methods. We reviewed 1305 kidney Tx biopsy samples obtained between 2006 and 2020. The biopsy specimens were divided into post-Tx GN (recurrent or de novo) and control groups (i. e., no detectable GN in biopsy). Demographic and baseline characteristics of the patients and kidney survival rates were analyzed. Results. From 1305 kidney transplanted biopsies, 350 repeated biopsies for transplant rejection were excluded. Among 955 analyzed biopsies, (mean age: 40. 4 ±,13. 48 years, mean transplantation duration: 4. 54 ±,3. 98 years, 74. 6% males), the frequency of GN was 10. 78%. The most common recurrent post-Tx GN was IgA nephropathy (22. 3%), followed by secondary focal segmental glomerulonephritis (FSGS, 19. 4%), primary FSGS (19. 4%), and membranous glomerulonephritis (17. 5%). In the post-Tx GN group, the mean serum creatinine and proteinuria were 3. 28 ±,1. 97 mg/dL and 2730 ±,1244 mg/d at the biopsy time and 4. 14 ±,1. 86 mg/dL and 2020 ±,1048 mg/d, at the end of the study. There was a significant relationship between baseline serum creatinine and graft loss (P <. 001). One-, five-, and ten-year graft survival rates were 97%, 81%, and 63% in the post-Tx GN, and 100%, 92%, and 59% in the control group. The median time to graft loss after biopsy, (graft survival after biopsy), was significantly lower in the post-Tx GN group (P <. 000). The other accompanying factors had no significant impact on graft survival. Conclusion. The median time to graft loss after biopsy was significantly lower in post-Tx GN. Baseline serum creatinine had a significant association with graft loss. Optimal management of recurrent or de novo GN should be a main focus of post-transplant care.