Medicinal plants for renal injury prevention

It has been estimated that about 20% of men and 25% of women between the ages of 65 and 74 have some degrees of chronic kidney. This complication is attributed to oxidative stress. Oxidative stress is an important factor contributing to kidney damage by increasing production of oxidants, particularly insufficiency of endogenous antioxidant defense system. Medicinal plants antioxidants are able to ameliorate oxidative induced kidney damage by reduction of lipid peroxidation and enhancement of scavenging ability of antioxidant defense system. Supplementation of medicinal plants antioxidants might be considered important remedies to abrogate pathology of oxidative stress induced kidney damage, however, single antioxidants do not act the same and might not be beneficial.

Complexity of diabetic nephropathy pathogenesis and design of investigations

Diabetic nephropathy (DN) pathogenesis is very complex and multifactorial. There are several mechanisms or pathways that hyperglycemia leads to renal injuries. Each pathway makes renal injuries via several mediators. Some mediators are common between the pathways such as reactive oxygen species (ROS) and TGF-β and there are many overlaps and interference between the pathways. This review summarized complexity of DN pathogenesis and overlaps or interfering of mediators between the pathogenesis pathways. Besides, in the review suggested new designs of researches based on this complexity pathogenesis. The pathogenesis of DN is certainly very complex and multifactorial. From the overview of molecular mechanisms of DN pathogenesis, there are many pathways and many mediators with many interferences and overlaps between them. The focal point of this pathogenesis still unknown but it seems that RAAS system, oxidative stress and TGF-β relatively are common between these complex tangle webs of pathogenesis.

Renoprotective effects of metformin

Metformin as a biguanid drug entered to the market 50 years ago and now is generally recommended as the first-line treatment in type 2 diabetes, especially in overweight patients, however in recent years new indications for its use have emerged . It improves peripheral and liver sensitivity to insulin, reduces basal hepatic glucose production, increases insulin-stimulated uptake and utilization of glucose by peripheral tissues, decreases hunger and causes weight reduction.Recently, much attention has been made toward the possible kidney protective efficacy of metformin. Recent studies have proven that metformin, possesses antioxidant properties, too.

Preliminarily Analysis of Carbamazepine (CBZ) C0 in Patients Visited Isfahan Epileptic Clinics

BACKGROUND

Carbamazepine (CBZ) is mostly considered as the first line of effective treatment against simple or complex partial seizure and primary-secondary generalization. To prevent side-effects related to higher amount of CBZ minimum concentration (C0) in body fluid or seizure attacks associated to lower amount of CBZ-C0, the suggested minimum therapeutic concentrations range from 4 to 12 ng/ml (according to previous publications). The aim of this preliminarily study was to investigate the scope of discrepancy associated to the C0of CBZ in patients visited Isfahan Epileptic Clinic.

METHODS

A cross-sectional study of 22 patients located in neurology ward of Isfahan Neurosciences Research Centre (INRC) was carried out between April 1, 2012 and December 31, 2012. Female (n = 9) and male subjects (n = 13) with a mean age of 27.4 years (range; 16-38 years) were studied. Pharmacological (CBZ-C0) and demographical variables were recorded and processed in excel.

RESULTS

The results of CBZ-C0 showed wide inter-individual variability. The mean value of CBZ-C0 was 7.2 ng/ml. In 10 out of 22 patients, CBZ-C0 were lower than the suggested therapeutic window (4-12 ng/ml). CBZ-C0 in nine patients was non-detectable and in one patient was 0.5 ng/ml (45% < 4 ng/ml). In 55% of the patients, CBZ-C0 ranged from 4.8 to 12 ng/ml.

CONCLUSIONS

A schedule therapeutic drug monitoring based on measurement of CBZ-C0for individual patient could be a practical marker to achieve therapeutic objectives. Further study related to correlating of CBZC0to clinical events in Iranian Epileptic population seems to be valuable.

Association of proteinuria with various clinical findings and morphologic variables of oxford classification in immunoglobulin a nephropathy patients

BACKGROUND

Immunoglobulin A nephropathy (IgAN) with nephrotic syndrome is an uncommon form of IgAN. Clinical and morphological characteristics of proteinuria in IgAN, especially when is in nephrotic range have not yet been fully examined. This study was aimed to correlate morphologic variables of the Oxford classification, and various clinical data with proteinuria in IgAN patients. We also aimed to demonstrate the significance of prevention of proteinuria as one of the important factors in progression of this disease.

METHODS

In an observational study conducted on IgAN patients, total of 114 biopsies were entered in the study. IgAN was diagnosed by light and immunofluorescence study.

RESULTS

Of 114 patients 70.2% were male. Mean age of patients was 37.7 ± 13.6 years. The mean of proteinuria was 1742 ± 1324 mg/day. Also mean of serum creatinine (Cr) was 1.6 ± 1.5 mg/dL. Of 114 patients, 11(9.6%) had nephrotic range proteinuria. In this study, there was a positive correlation between proteinuria and serum Cr, peri-glomerular fibrosis or interstitial fibrosis. There was a positive association between proteinuria and totally sclerotic glomeruli too. There was also a positive association between the amount of fibrous crescents and the level of proteinuria. Nephrotic proteinuria could just be seen in male patients. Also, nephrotic syndrome had a positive association with the number of crescents.

CONCLUSIONS

Our findings firstly support the prognostic value of crescent due to its association with proteinuria and secondly imply the importance of treatment of proteinuria to prevent progression of IgAN.

Preliminary study related the incidence of methylprednisolone pulse therapy in patients visited multiple sclerosis clinic located at the isfahan kashani hospital

BACKGROUND

To manage relapsing-remitting multiple sclerosis (MS) in the course of acute exacerbations, methylprednisolone (MP) (Medrol or Solu-Medrol), has the ability to lock the injured blood-brain barrier and decrease irritation in the central nervous system. The aim of this preliminary study was to investigate the frequency and time interval related to MP pulse therapy in patients with MS.

METHODS

This Study is conducted in the MS clinic of the Isfahan Kashani hospital, that was carried out on patients (n = 901) from June 2011 to December 2012. Patients who visited MS clinic just for once disinterested from analysis. According to the incidence of MP pulse therapy in females and males, two groups were made. Group 1 included patients with 2-3 times and Group 2 included patients with more than 4 times pulse therapy. Demographical data, pharmacological variables including number and time interval related to pulse therapy for each individual were recorded in dBase. The statistical analyses of d-Base were performed using SPSS.

RESULTS

901 patients in 1592 occasions were studied. The mean age of patients was 34.6 years old (ranged: 8-87 years old). 586 patients included 465 females and 121 males visited MS clinic just for once. 245 females in 797 occasions and 70 males in 209 occasions received pulse therapy with a mean of 4 times (ranged: 2-11 times). 51.1% and 48.9% of patients received MP pulse therapy for two and more than two up to 11 times respectively. In the 70% of the patients' time interval between pulse therapy was with a mean of 137 days (ranged: 28-480 days).

CONCLUSIONS

For pulse therapy, it seems that the female subjects refer to clinic are approximately 3.7 times higher than male subjects. To reduce the demand of patients to pulse therapy, disease management could be rationalized on the basis of illness expansion and its correlation to inter and intra individual variability. Finally, to understand the effectiveness of pharmacotherapy, in MS population (Isfahan/Iran), clinical neuropharmacology in relation to better understand of the individualized pharmacokinetics could be useful.

Immunoglobulin A Nephropathy and Malaria falciparum Infection; a Rare Association

Glomerular involvement occurs as a rare form of renal manifestation in Plasmodium falciparum malaria. Here, we report a rare case of falciparum malaria-associated IgA nephropathy. A 28-year-old man was admitted because of fever and abdominal pain. Ultrasound and computed tomography (CT) showed right kidney pyonenphrosis. Despite placing a nephrostomy tube, fever continued. Repeated CT was in favor of focal pyelonephritis. In addition, peripheral blood smear suggested malaria. Anti-malarial drugs were initiated and right nephrectomy was performed. One year after recovery from malaria, a persistent rise in serum creatinine was detected. A left kidney biopsy showed mesangial proliferation and dominant IgA deposits in immunofluorescence study while C1q was not deposited. The impression was IgA nephropathy with M1E0S0T0 of Oxford classification. The patient was prescribed a combination of low dose prednisolone and angiotensin converting enzyme inhibitor. Six months after treatment serum creatinine decreased from 1.6 mg/dL to 1.3mg/dL and urine abnormalities were disappeared. Our findings suggest that malaria infection might be associated with IgA nephropathy.

What is the Real Fate of Vitamin D in Multiple Sclerosis?

Multiple sclerosis (MS) is a multifactorial disease (caused by both environmental and genetic features) that could results from a demyelination of the myelin sheath. Subsequently, it leads to many scars or lesions in different places within the central nervous system. The symptoms that occur depend on the site and rigorousness of the lesions and this is why people with MS experience different symptoms. Although, it is not clearly known that why people develop MS, research suggests that vitamin D plays a key role in preventing or repairing the damaged myelin. Previous studies have shown that vitamin D is a potent natural immune-regulator and has an anti-inflammatory action. Increased exposure to vitamin D may result in changed immunologic profiles or commotion that donates to MS risk. Vitamin D deficiency is caused by insufficient sunlight exposure or low dietary vitamin D3 intake. Recent studies have also indicated that, there are several polymorphisms for vitamin D receptor (VDR) gene, but the effect of VDR gene polymorphisms on protein function of VDR and how exerts second signaling pathways in cells is still unknown. Therefore, this review focuses on vitamin D metabolism and genetic polymorphisms related to VDR and MS to better understand of discrepancies among patients.

The NF-κB specific inhibitor DHMEQ prevents thrombus formation in a mouse model of antiphospholipid syndrome

BACKGROUND

β2-glycoprotein I (β2GPI)-dependent antiphospholipid antibodies (aPLs) are considered to play a pivotal pathogenic role in antiphospholipid syndrome (APS) by inducing the expression of tissue factor, inflammatory cytokines, and chemokines, most of which are dependent upon the NF-κB pathway. Therefore, the NF-κB is regarded as a promising target for the development of a novel therapeutic strategy. However, progress has been limited owing to the fact that there are no widely-used in vivo models, or highly specific inhibitors.

OBJECTIVE

This study aimed to test the effects of an NF-κB-specific inhibitor, DHMEQ, in preventing thrombus formation using an original mouse model of APS.

MATERIALS AND METHODS

Specificity of a monoclonal aPL WB-6 was examined by ELISA. WB-6 was injected into normal BALB/c mice with or without DHMEQ treatment. A pulse laser was radiated to a cutaneous vein in the window of a dorsal skinfold chamber attached to the mouse and thrombus formation was observed and recorded under a microscope.

RESULTS

WB-6 bound preferentially to the caldiolipin (CL)-β2GPI complex rather than to CL alone, or β2GPI alone. WB-6, but not isotype-matched control antibody, induced a prothrombotic state in the mice by inducing tissue factor expression upon circulating monocytes, resulting in thrombus formation at the site of laser-induced endothelial injury. This diathesis was almost completely ameliorated by DHMEQ treatment.

CONCLUSIONS

Inhibition of the NF-κB pathway is a promising strategy for the development of a novel treatment for APS.

A quick review of carbamazepine pharmacokinetics in epilepsy from 1953 to 2012

BACKGROUND

Carbamazepine has been used as AEDs since 1965, and is most effective against partial seizures. Two basic mechanisms of action have been proposed: 1) enhancement of sodium channel inactivation by reducing high-frequency repetitive firing of action potentials, 2) and action on synaptic transmission. The aim of this study was to provide a review of carbamazepine pharmacokinetics and its management guidelines in Iranian epileptic population.

MATERIALS AND METHODS

Directory of Open Access Journals (DOAJ), Google Scholar, Pubmed (NLM), LISTA (EBSCO), Web of Science were searched; 1600, 722 and 167 research and review articles relevant to the topics; carbamazepine pharmacokinetics, carbamazepine pharmacokinetics in epilepsy and review on carbamazepine pharmacokinetics in epilepsy were found, respectively.

RESULTS

Carbamazepine is highly bound to plasma proteins. In patients the protein-bound fraction ranged from 75-80% of the total plasma concentration. Bioavailability ranges from 75-85%. The rate or extent of absorption was not be affected by food. It is completely metabolized and the main metabolite is carbamazepine-epoxide (CBZ-E). Carbamazepine induces its own metabolism, leading to increased clearance, shortened serum half-life, and progressive decrease in serum levels. Increases in daily dosage are necessary to maintain plasma concentration. Severe liver dysfunction may cause disordered pharmacokinetics. In cardiac failure, congestion of major vital organs, including kidneys, may result in abnormally slow absorption and metabolism.

CONCLUSION

Carbamazepine shows variability due to its narrow therapeutic window. Therefore clinical management in a3n Iranian epileptic population should focus on results derived from therapeutic drug monitoring in order to reduce inter and intra- individual variability in plasma drug concentrations.

Efficacy of Co-administration of Garlic Extract and Metformin for Prevention of Gentamicin-Renal Toxicity in Wistar Rats: A Biochemical Study

BACKGROUND

Gentamicin (GM) nephrotoxicity has been related to oxidative stress. Garlic and metformin (MF) have anti-oxadant activity and therefore, this study was aimed to evaluate the preventive and curative effects of garlic, MF and their combination on GM indeced tubular toxicity in Wistar rats.

METHODS

In a pre-clinical study, 70 male Wistar rats were randomly designated into 7 groups of 10 and treated as follows: Group 1: Received saline for 20 days. Group 2: Were injected 100 mg/kg/d of GM intraperitoneally (ip), for 10 days and saline for 10 more days. Group 3: Received GM for 10 days then 20 mg/kg garlic ip for the next 10 days. Group 4: Received GM for 10 days and MF (100 mg/kg) orally for the next 10 days. Group 5: Received GM for 10 days and a combination of MF and garlic for the next 10 days (100 and 20 mg/kg, respectively). Group 6: The same as group 5but with half-doses of MF and Garlic. Group 7: Received GM for 10 days together with a combination ofMF and garlic. On 20(th) day of the experiment the serum blood urea nitrogen (BUN) and creatinine (Cr) were measured and compared in different groups.

RESULTS

GM injection significantly increased the serum BUN and Cr (P < 0.05). Administration of MF, garlic or their combination with or after injection of GM (high doses) could atenuate BUN and Cr.

CONCLUSIONS

The results indicate that MF and garlic or their combination have curative and protective activity against GM nephrotoxicity.

Preventive and curative effects of ginger extract against histopathologic changes of gentamicin-induced tubular toxicity in rats

BACKGROUND

Gentamicin (GM) is a commonly used aminoglycoside, however, renal toxicity has limited its usage. This study was designed to evaluate the curative and protective effects of Zingiber officinale (ginger) against gentamicin tubular toxicity in rats. The phenolic and flavonoid components and antioxidant activity of ginger were also evaluated.

METHODS

In a preclinical study, 50 male Wistar rats were designated into 5 groups of 10 and treated as follows: Group I: vehicle. Group II: 200 mg/kg/d of ginger for 3 days then, GM (80 mg/kg) for 7 days. Group III: 200 mg/kg ginger orally for 3 days, then ginger plus GM for 7 days. Group IV: GM for 7 days. Group V: GM for 10 days. Group VI: GM for 7 days, then 200 mg/kg ginger orally for 10 days. At the end of the study, the animals were sacrificed and their kidneys were histologically evaluated.

RESULTS

Ginger could prevent degeneration of the renal cells and reduce the severity of tubular damage caused by gentamicin. However, it could not regenerate the GM degeneration.

CONCLUSIONS

The results indicate that ginger is effective as a prophylaxis agent, but has not curative effect.

Comment on: Anti-Oxidative Stress Activity of Stachys lavandulifolia Aqueous Extract in Humans

A recent article by Rahzani et al. (1) published in the esteemed Cell Journal reported the antioxidative stress activity of Stachys lavandulifolia aqueous extract in humans and suggested its consumption as a supplement in the management of diseases related to oxidative stress. We would like to emphasize some of the limitations regarding antioxidant supplementation, in general, and Stachys lavandulifolia, in particular. It has been established that oxidative stress is involved in the development of a wide variety of chronic and degenerative diseases such as cancer, Parkinson and Alzheimer's (2-5). Antioxidants are also effective in the prevention or reduction of adverse effects related to medication usage (5-10). However, they may potentially have deleterious effects. A major concern of antioxidant supplementation is their harmful effect on reactive oxygen species (ROS) production (prooxidant action), particularly when precise modulation of ROS levels are necessary for normal cell function (4-10). In fact, it has been reported that antioxidants may exhibit pro-oxidant activity under specific conditions. Of particular importance are redox conditions the dosage and the presence of free transition metals at cellular sites. For example, the antioxidant vitamin C in the presence of ferric iron may act as a potent mediator of lipid peroxidation. It has been suggested that β-carotene sometimes acts as a pro-oxidant in the lungs of smokers and similarly vitamin C may increase DNA damage in humans (11, 12). Therefore, it is necessary to take into account the bioavailability and differential activities of antioxidant compounds before their administration. Other than general considerations for antioxidant consumption, the aspects of each particular antioxidant should also be considered (3, 13, 14). Recently, in a preclinical study we reported the renal toxicity of hydroalcoholic extract of Stachys lavandulifolia Vahl in Wistar rats (15). In this experimental study we randomly assigned 100 male Wistar rats to five equal groups, one control and four experimental. Animals received intraperitoneal injections of saline or Stachys lavandulifolia extract (50, 100, 150, 200 mg/kg) for one month after which blood samples were collected from half of the animals from each group. Other animals received no injections for one additional month, then blood samples were obtained. In the groups that Stachys lavandulifolia Vahl extracts were used for one month we observed mild degeneration of renal tubular epithelial cells (6, 9). In the second month of the study these histologic lesions significantly increased (p< 0.05). We concluded that hydroalcoholic extract of Stachys lavandulifolia has renal tubular toxicity which might continue following drug discontinuation (6, 9, 15). Therefore, although antioxidant supplements generally have beneficial effects, as a caution it is advised to only consume such supplements under medical supervision in order to avoid any potential negative effects.

Association of serum uric acid with proteinuria in type 2 diabetic patients

BACKGROUND

Various findings suggest that uric acid is an inflammatory factor and may have a role in endothelial dysfunction and act as a mediator of diabetic nephropathy. The objective of this study was to evaluate the relationships between serum uric acid level and level of proteinuria in type 2 diabetic (T2D) patients.

MATERIALS AND METHODS

A cross-sectional analytical study was conducted in 60 patients with T2D without a history of gout. None was treated with allopurinol. Venous blood samples were obtained in fasting state for determinations of serum creatinine, uric acid, and hemoglobin A1c (HbA1c) (reference range 3.8-5.5%); 24-h urine proteinuria was also measured.

RESULTS

Mean age of the patients was 57 ± 8.3 years. Mean ± standard error (SE) of serum creatinine was 0.98 ± 0.028 mg/dL, mean ± SE of serum uric acid was 4.5 ± 0.15 mg/dL, and mean ± SE of proteinuria was 388 ± 28.7 mg/day (median = 303.5 mg/day). There was no significant difference in serum uric acid, HbA1c, and creatinine level between males and females (P > 0.05). There was a significant positive association between body mass index (BMI) and serum uric acid levels (r = 0.428, P = 0.001). After adjustment for weight, a significant positive association of serum uric acid with level of proteinuria was seen (r = 0.47, P < 0.001).

CONCLUSION

Serum uric acid had a significant positive association with diabetic nephropathy. It might be hypothesized that serum uric acid plays a role in diabetic nephropathy in T2D.

Estrogen Abolishes Protective Effect of Erythropoietin against Cisplatin-Induced Nephrotoxicity in Ovariectomized Rats

Introduction. Nephrotoxicity is one the side effect of cisplatin therapy and erythropoietin has been candidate as a nephroprotectant agent. However, its nephroprotective effect when it is accompained with estrogen has not been studied in female. Methods. 27 ovariectomized female Wistar rats divided into five groups. Groups 1 & 2 received estradiol valerate (0.5 mg/kg/week) for four weeks, and single dose of cisplatin (7 mg/kg, ip) was administrated at the end of week 3. Then the group 1 was treated with erythropoietin (100 U/kg/day), and the group 2 received vehicle during week 4. Groups 3 and 4 were treated similar to group 1 and 2, except for placebo instead estradiol valerate. Group5 (negative control) received placebo during the study. Animals were killed at the end of week 4. Results. In non-erythropoietin treated rats, cisplatin significantly increased the serum levels of blood urea nitrogen and creatinine (P < 0.05). However, these biomarkers significantly decreased by erythropoietin (P < 0.05). The weight loss, kidney weight, and kidney tissue damage score in rats treated with cisplatin but without estradiol were significantly less than the values in similar group when estradiol was present (P < 0.05). Conclusion. It seems that erythropoietin could protect the kidney against cisplatin-induced nephrotoxicity. This protective effect was not observed when estrogen was present.

Chronic kidney disease in children: A report from a tertiary care center over 11 years

BACKGROUND

Chronic kidney disease (CKD) is an overwhelming illness in children. Considering the importance of CKD in pediatric age group, in addition to the racial and ethnic differences in prevalence and etiology of CKD, epidemiologic studies are recommended. The majority of the results regarding the incidence of CKD have been achieved from studies on hospitalized children.

OBJECTIVES

This study evaluates the incidence and etiology of chronic renal failure (CRF) in children in a tertiary care center in Isfahan, the second large province of Iran.

PATIENTS AND METHODS

A retrospective analysis of medical record data of children less than 19 years old, hospitalized for CKD at St Alzahra hospital, Isfahan, Iran, during the period of November 2001 until December 2011 was made. A total of 268 eligible cases were recruited. Patients were categorized into 5 groups according to glomerular filtration rate (GFR) and KDOQI guideline.

RESULTS

Out of 268 patients, 144 patients were male (54%). The mean and median of age was 11.01± 0.39(SD) years and 12.5 years, respectively. Approximately 55% of patients had either systolic and/or diastolic hypertension. The most frequent etiology of CKD was glomerular diseases (34%) followed by reflux nephropathy (16.7%). Most patients (74.8%) had GFR less than 15 ml/min/m², when diagnosed. Anemia was the most prevalent laboratory abnormality (85%). Small-size kidneys were seen in 65.8% of patients. Kidney replacement therapy (either hemo- or peritoneal dialysis) was applied for 72.3% of the patients. The transplantation rate average was 7.2 per million children population. The annual incidences of CKD (mostly advanced stages) were 5.52 per million population (PMP) and 16.8 per million children population, respectively. The all cause of mortality rate was 18.4%. Younger age was the only independent predictor of mortality (p=0.005).

CONCLUSIONS

We concluded that glomerular diseases are the leading cause of CKD in our patients. In addition, the annual incidence of CKD is considerably high.

Mucormycosis and acute kidney injury

Mucormycosis, although said to be less common than candidiasis and aspergillosis is becoming increasingly associated with many co-morbid conditions and immunosuppression. Renal involvement, rarely reported previously, has also been documented with increasing frequency in recent times in both diseased as well as apparently healthy individuals. The kidneys may be involved in disseminated disease or have an isolated involvement for unexplained reasons. The manifestations are very serious particularly in patients with bilateral renal mucormycosis who often develop acute kidney injury and usually have a fatal outcome. The diagnosis of the renal mucormycosis is based on renal histology sections of renal biopsy or nephrectomised kidneys. Imaging with computerised tomography with contrast is of tremendous help in early identification of these cases before histological diagnosis. Once diagnosis is established, prompt treatment with antifungal medication, including Amphotericin-B (and its lipid formulations) and posaconazole, and removal of infected tissue is necessary to save from otherwise fatal infection.

Correlation between sacral ratio and primary enuresis

BACKGROUND

Enuresis is defined as the repeated voiding of urine into clothes or bed at least twice a week for at least 3 consecutive months in a child who is at least 5 yr of age and has a high prevalence in school aged children. In primary enuresis (PE) children have never gained control over urination or has been dry for<6months. While in secondary enuresis children have developed incontinence after a period of at least 6 months of urinary control.

OBJECTIVES

The aim of this study was to investigate a possible relation between PE and sacral ratio (SR) in 5-9 aged children.

PATIENTS AND METHODS

118 children with aged 5-9 year were enrolled in this case-control study. All them were divided into two aliquots groups of 59 patients. The case study (children with PE) and the control (children without PE) groups were matched in age and sex. SR based on antero-posterior plain radiograms of pelvis was calculated. Results were then analyzed using Chi square and student t-test as appropriate.

RESULTS

There were no significant differences between the two groups regarding age and gender. Mean SR in case and control group was 0.89 and 0.90, respectively. Moreover, there was no significant difference between the two groups (p=0.82). Only 1 child (1.6%) in case group showed abnormal SR while this was 7 children (11.9%) in the control group.

CONCLUSIONS

This study showed that, there was no significant difference between children with PE and those without PE in terms of SR. However, multicenter and larger sample size is recommended for definite decision of this finding.

Deficits in retrospective and prospective components underlying prospective memory tasks in amnestic mild cognitive impairment

OBJECTIVES

By use of purer indices of PM and RM components than previous studies and adoption of three PM task types, the present study aimed to investigate the deficits of these two components underlying global impairment at a PM task in individuals with amnestic mild cognitive impairment (aMCI).

METHODS

Nineteen aMCI patients and 22 normal controls were examined on event-, time- and activity-based PM tasks. Separate scores were obtained for initiation of intentions (i.e. PM component) and for the content of the intentions (i.e. RM component).

RESULTS

Individuals with aMCI achieved lower PM component (but not RM component) scores than NCs across all three PM tasks. Furthermore, there was a trend for greater impairment on activity-based than time-based and event-based PM tasks, but which did not reach significance. In addition, a significant association between PM component and an executive function test was observed in aMCI group. PM task performance, especially activity-based PM task performance and PM component performance, successfully discriminated between aMCI and NC and was able to do so above and beyond the executive function tests.

CONCLUSIONS

Our finding suggested that the deficits in PM component, related to a disrupted executive control processes, were responsible for the impaired ability of individuals with aMCI to realize delayed intentions.

Inhibition of gentamicin-induced renal tubular cell necrosis

Gentamicin nephrotoxicity limit its usage against gram negative bacteria. Most researches showed that antioxidant agents improved gentamicin nephrotoxicity. According to these investigations oxidative stress play a central role in the mechanism of gentamicin induced nephrotoxicity. Recently Rafieian-Kopaei and colleagues showed that erythropoietin significantly ameliorated serum creatinine, blood urea nitrogen and tubal necrosis in gentamicin induced nephrotoxicity in rat. One of the advantages of this study is treatment of rats for 10 days by erythropoietin after inducing gentamicin nephrotoxicity and besides co- treatment of gentamicin and erythropoietin at 10 days simultaneously. They showed that erythropoietin improved significantly serum creatinine and blood urea nitrogen in gentamicin injected rats simultaneously and even after gentamicin nephrotoxicity induction. This study also showed that erythropoietin ameliorates histopathological injuries especially tubular cell necrosis that induced by gentamicin. Although the detailed renoprotective mechanisms of erythropoietin cannot be fully explained by this study but histological and biochemical results are satisfactory.

Erythropoietin; bright future and new hopes for an old drug

Recent publications have suggested renoprotective actions for erythropoietin in certain models of acute kidney injury. In a study by Rafieian-Kopaei et al., the effects of erythropoietin on amelioration of gentamicin-induced renal toxicity was investigated and renoprotective effect for Eprex, an analogue of erythropoietin was shown when the drug was given in combination with gentamicin. There has also been a protective effect when the drug was applied after gentamicin administration. Thus, the drug was effective even after induction of tubular damage which opens a very valuable window for its therapeutic actions. However, there are still needs for studies on the mechanisms which are involved in these protective actions.

Erythropoietin ameliorates genetamicin-induced renal toxicity: A biochemical and histopathological study

BACKGROUND

Investigations have attempted to modify the outcome of tubular injury by either ameliorating renal tubular damage or promoting tubular regeneration in the case of acute tubular necrosis.

OBJECTIVES

We investigated the protective effect of Eprex an erythropoietin analogue on tubular injury induced by gentamicin (GM).

MATERIALS AND METHODS

Forty male Wistar rats were randomly divided into four groups. In group 1,rats were served as a sham group. In group 2, rats were injected intraperitoneally with 100 mg/kg of GM for 10 consecutive days (positive control group) and then were sacrificed. In group 3, rats received GM for 10 days then Eprex 100U/kg was injected intraperitoneally for the next 10 days and then they were sacrificed at the day 20th. In group 4 rats were injected a combination of GM (80 mg/kg) and Eprex 100U/kg intraperitoneally for 10 days and then were sacrificed.

RESULTS

The results indicated that, Eprex prevented the increase in serum creatinine (Cr) and blood urea nitrogen (BUN). The effect of Eprex on damage score, showed that co-administration of GM and Eprex (group 3 and 4) reduced the kidney tissue damage compared to positive control group (P<0.05). This result indicat that Eprex potentially can reduce or prevent the kidney tissue damage.

CONCLUSIONS

Ameliorative effect of Eprex when the drug was given in combination with GM and also when the drug was applied after GM-induced tubular damage, revealed the renoprotective potency of Eprex. Eprex is a promising drug to prevent or attenuate tubular damage induced by GM or other nephrotoxic agents which act through the same mechanisms as gentamicin.

Ameliorative effects of metformin on renal histologic and biochemical alterations of gentamicin-induced renal toxicity in Wistar rats

BACKGROUND

The aim of this study was to test the potential properties of metformin (MF) to protect the kidney from gentamicin (GM)-induced renal toxicity.

MATERIALS AND METHODS

In this preclinical study, 50 male Wistar rats were randomly divided into five groups of 10 rats in each. In the first group (group I), they were kept in the same condition as others without receiving drugs for 10 days. In group II, the rats were injected intraperitoneally with 100 mg/kg/day of GM for 10 consecutive days. Group III rats received 100 mg/kg/day MF orally for 10 days. In group IV, the rats received GM (100 mg/kg; intraperitoneally) for 10 days and 100 mg/kg/day MF orally for the next 10 days. In the last group (group V), the rats received a combination of GM 100 mg/kg/day intraperitoneally and MF 100 mg/kg/day orally for 10 days simultaneously. Serum blood urea nitrogen (BUN) and creatinine (Cr) values were measured and renal tissues of the animals were processed for light microscope examination.

RESULTS

The levels of BUN in groups II, IV, and V, and also the serum level of Cr in groups II and V were increased significantly after the experiment. Furthermore, post-treatment with MF or co-treatment with MF could prevent the elevation of serum BUN and Cr induced by GM and also attenuates the damage score (P < 0.05).

CONCLUSIONS

MF may prevent or ameliorate GM-induced acute renal failure, and therefore it might be beneficial in patients under treatment with this medicine.

Collapsing focal segmental glomerulosclerosis: Increasing the awareness

Collapsing focal segmental glomerulosclerosis (cFSGS), also known as collapsing glomerulopathy (CG) is of considerable interest for a variety of reasons. Its incidence is on the rise, and in many parts of the world, it has emerged as one of the leading causes of end-stage renal disease (ESRD). There is currently no specific treatment and the response to standard immunotherapeutic agents is poor. Majority of the cases have been reported from the western countries, but the lesion is also being increasingly recognized in the tropical regions. It is imperative to increase the awareness of the lesion among the pathologists and the nephrologists from the developing countries for its accurate diagnosis and appropriate prognostication.