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Introduction: Compensatory renal growth (CRG) is growth of the remaining functional nephrons and interstitium alter some nephrous have been surgically removed or damaged due to disease. This growth includes the increase of kidney weight caused by hepertrophy and hyperplasia. Although uremic patients are often treated with growth hormone (GH), it is thought that GH may actually increase the degree of renal hypertrophy and the progress of CRG to the scarring and therefore accelerate renal failure. The aim was ultrastructural study of the effects of recombinant human growth hormone (rhGH) on the renal tubulointerstitial changes following 5/6 nephrectomy (SNX).
Materials and Methods: For this 48 rats from mule Lewis and Dwarf Lewis rats strains were used. Each strain was divided to control, control+rhGH, SNX and SNX+rhGH groups. Dwarf rats strain have only 10% of circulating GH compared to the normal strain one month later the rats were injected with exogenous growth hormone (thGH) or saline two times per day for 30 consecutive days.
Results: The results showed tubular basement membranes was partially thickened in control thGH group and it was too thickened and multi-layered in the SNX groups. Tubular basement membrane was too thickened in the SNX-TGH group in compared to SNX only. Many of Convoluted tubules lost their apical architecture and mitochondria often appeared damaged and cytoplasm contained increased numbers of lysosomes. After SNX areas of focal fibrosis were common. These areas were become infiltrated with modified fibroblasts and myofibroblasts were present. The interstitium become filled with extracellular fibres and amorphous material.
Conclusion: It is evident that many of these changes were made more sever by treatment with thGH in both strains following SNX. So it seems GH caused more synthesis of extracellular matrix proteins and ultrastructural changes of the renal tubulointerstitial.

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Introduction: Peptic ulcer is a mucosal lesion of stomach or deodenum in which acid and pepsin play major pathogenic roles. In general population, Helicobacter pylori (HP) plays an important role in peptic ulcer. Peptic ulcer is more common in chronic renal failure (CRF) but its etiology is unknown. Materials and methods: In a descriptive cross-sectional study, the prevalence of peptic ulcer in CRF patients was studied and its relationship with HP was evaluated. All patients were visited in Tajrish shohada hospital, Tehran. CRF was defined as a serum ceratinin concentration equal or more than 2 mg/dl at least for 3 months. Patients who stressful conditions, or were recieved immunosuppressive or NASID drugs, or drugs for eradication of HP were excluded. Upper GI endoscopy was performed for all patients by gastroentrologists to find out peptic ulcer. Biopsy was taken for HP identification by rapid ureas test. Results: The mean age of participants was 56 year and 51% of them had GI symptoms. Nineteen of 98 patients with CRF (19%) had peptic ulcer. That 5 of them were positive HP. HP was identified in 45 (46%) of patients. Conclusion: This study showed that HP is not more prevalent in CRF patients compared to general population. Additionally, peptic ulcer was more common in male patients with CRF than non-CRF subjects.

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Introduction: Renal cell carcinoma can be presented with extension of thrombosis to renal vein and inferior vena cava. Management of these patients consists of radical nephrectomy and thrombectomy. In this study we reviewed approach to these patients. Materials & Methods: This is a case series report. During 1379 to 1384, 148 patients diagnosed with renal cell carcinoma (RCC) limited to Gerota’s fascia (stage T3 or less) were admitted to Hasheminejad hospital. Fourteen patients had inferior vena cava (IVC) involvement. Radical nephrectomy as well as thrombectomy was performed in 8 patients. This investigation is done on these 8 patients. Results: Patients' average age was 51.4 years. Six patients were male (75%) and 2 female (25%). The most common symptoms were flank pain (75%), gross hematuria (62.5%) and structural symptoms (50%). All patients had tumors limited to Gerota’s fascia without any distant metastasis. Infrahepatic involvement of IVC was seen in 6 patients and in 2 patients thrombosis extended above the hepatic vein (infrahepatic). No perioperative mortality was seen. Postoperative complications were atelectasia in 2 patients and deep vein thrombosis in one which was treated with conservative management. Conclusion:By skillful surgical approach in patients with RCC and IVC involvement, thrombosis can be completely excised without increasing the rate of complications and longterm survival could be expected.

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Introduction: End stage renal disease (ESRD) is a major health problem and each year the number of patients is increasing. If the disease becomes irreversible, patients must always be hemodialyzed. Since mortality rate will increase due to inadequate dialysis, determining the efficacy of hemodialysis and improving its quality is very important. The main goal of this research is investigating the efficiency of hemodialysis. Materials and Methods: This is a cross-sectional analytical study which was conducted on 103 people who were under dialysis treatment in the Vali-e-Asr hospital of Arak in year 2003. Weight, blood pressure (before and after dialyze), time of dialysis, BUN and Cr before dialysis and 5 minutes after turning of the pump and before the second dialysis were measured. Data was analyzed by T test and Pearson correlation. Results: The mean of KT/V was 0.58 ± 0.1 normal protein catabolic rate (nPCR), 0.36 ± 0.11 g/kg per day and time average concentration of urea (TAC), 43.3 ± 14 mg/d which had a significant difference with standard measures (p<0.05). KT/V was 0.49 ± 0.18 and 0.47 ± 0.10 for men and women respectively which was significantly different (p<0.03). There was a positive and linear relationship between education level and TAC, KT/V and number of dialysis per week. Conclusion: Regarding the low efficiency of hemodialysis in 80% of patients and lower levels of hemodialysis efficacy indicators in comparison to standard measures, periodic assessment and also investigating the reasons of low efficacy of hemodialysis is recommended.

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Introduction: Secondary hyperparathyroidism (SHPT) is one of the serious complications in patients with chronic kidney disease (CKD). This study aimed to identify biochemical alterations of renal bone disease in hemodialysis patients of Qazvin province. Materials and Methods: In a descriptive study, fasting blood samples of arterio-venul shunt, before starting hemodialysis, were taken from all CKD patients and Ca++, P-- and ALP were measured by colorimetric methods and PTH by IRMA method. Descriptive statistics was used to present data. Results: In 4% of cases there were no abnormalities of mentioned parameters but in 96% of patients one or more parameters were abnormal. The most prevalent abnormality was related to P-- (increased) and the least one to ALP (increased). 51% of patients had raised PTH level (hyperparathyroidism) and higher abnormalities of other biochemical parameters. No differences were seen in the mean of age, duration and number of hemodialysis and also sex ratio of hyperparathyroid patients and all studied patients. Conclusion: The Biochemical and hormonal results revealed a predominance of mild to moderate secondary hyperparathyroidism and renal bone disease in CKD patients, so there is a need to control the disease with specific treatments.

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Introduction: Oral Ketamine is used as a low side effect analgesic in comparison with opioids, in different pain syndromes. This study is designed to evaluate the effect of oral Ketamine in renal colic treatment. Materials and Methods: In this clinical trial study 104 patients with renal colic, hospitalized in emergency department, were divided in to two groups by Random block design. Group B received Pethidine (1 mg/kg up to 100 mg) and placebo, and group A received Pethidine with the same dose and Ketamine (0.5 mg/kg). All patients were assessed for pain by using VAS chart, for nausea by a 0-3 scale and for the number of vomiting at baseline and 1, 2 and 3 hours after taking drug. The results were analyzed by t-test. Results: Average pain score and vomiting in all times and nausea score in one and three hours after receiving drugs were reduced significantly in patients who took Pethidine and Ketamine comparing patients who took Pethidine and placcbo(p < 0.05). Conclusion: Regarding the significant effect of Ketamine in reduction of pain, nausea and vomiting without side effects, it is possible to use Ketamine as an adjuvant drug in treatment of renal colic and to reduce narcotic dosage.

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Background: Urolithiasis is one of the causes of renal colic. The annual incidence of this disease is 1-2/1000 people. Due to the severity of pain, adverse effects of routine treatments and incomplete pain relief, more effective methods of treatment have always been sought for. Alhagi Pseudalhagi distillate is a traditional herbal medication used for urolithiasis. Due to its wide availability and no previous report of adverse effects, we decided to evaluate its impact on ureteral stone expulsion. Materials and Methods: In this single-blind randomized clinical trial, 100 renal colic patients whom visited in Arak Vali-asr Hospital or its clinics were divided into two groups. Group1 received Thiazide, Tamsulosin, and analgesics and group 2 received Alhagi Pseudalhagi distillate in addition to aforementioned drugs. The patients were followed upto 4 weeks and the stone expulsion rates and their times were compared. Results: The average stone sizes for groups 1 and 2 were 4.66 and 4.32 mm, respectively (p=0.128). Stones in both groups were mostly located in lower ureter (p=0.551). Expulsion occurred in 40% of group 1 and 66% of group 2 patients (p=0.009). The mean expulsion times for groups 1 and 2 were 11 and 9 days, respectively (p= 0.291). Conclusion: Alhagi Pseudalhagi distillate had a significant effect on the rate of stone expulsion and it is likely to decrease the time needed for the passage of Urolithiasis stones.

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Background: Noticing the fact that graft survival rate of kidney transplantation from live donors is more than deceased donors, this study was conducted to determine the relationship between the graft survival rate of renal transplantation and the donor source in patients transplanted from March 1999 to March 2009 in Namazi Hospital Transplantation Center of Shiraz. Materials and Methods: In this retrospective cohort study which was designed to determine the relationship between graft survival of kidney transplantation and the donor source (related live donor, unrelated live donor, and deceased donor) in 1356 patients who were transplanted in Shiraz Transplant Center, Namazi Hospital. Kaplan-Meier method was used to determine the survival rate, log-rank test was used to compare survival curves and Cox regression model was used for ruling out the intervening factors. Results: Five-year graft survival rates of renal transplantation from related, unrelated, and deceased donors were 92.4, 92.6 and 82.1%, respectively. Also, a significant relationship was seen between donor source and survival rate of the renal allograft (P>0.001). Conclusion: The findings of this study transplanted patients with kidneys from living donors (related or unrelated) have a higher graft survival rate compared with deceased donors.

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Background: Low immunogenicity of hepatitis B vaccine is an important problem in patients with chronic renal failure (CRF). A possible solution is intradermal versus conventional intramuscular delivery of vaccine in this population. The goal of this study was to compare the efficacy of these routes of vaccination in Bu-alicina Dialysis Center, Qazvin, Iran. Materials and Methods: This randomized clinical trial was done on 29 CRF non-responders randomly allocated to two groups. Fifteen patients received 40 μg of euvax B vaccine intradermally and 14 patients received 160 μg of this vaccine intramuscularly. Anti-HBs antibody titre was measured after 1, 6, and 12 months. Seroprotection was defined as anti-HBs antibody titre above 10 lU/L. Data were analyzed using SPSS software version 16. Results: Difference of seroprotection rate between two groups was not statistically significant after1and 6 months however, after 12 months, seroprotection rate was 93.3% in the interadermal group versus 50% in the intramuscular group (p<0.05). Conclusion: Considering the high cost of vaccination, intradermal vaccination may be a reasonable choice in CRF patients.

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Background: Pruritus is the most distressing symptom in hemodialysis patients. Its etiology has not yet been delineated thus, there are no good therapeutic options. Serotonin has been reported to be a mediator of uremic pruritus while ondansetron is a potent and selective inhibitor of 5-HT3 receptors. The aim of this study was to evaluate the effect of ondansetron on uremic pruritus in hemodialysis patients.

Materials and Methods: In this randomized double-blind clinical trial, 70 patients undergoing hemodialysis with moderate and severe itching were enrolled. They were randomly divided into two groups: one group received ondansetron 8 mg three times daily and the other group was given loratadine 10 mg two times a day for 2 weeks. Pruritus scores were recorded by the patients and the mean scores were compared before and after intervention.

Results: Changes in VAS scores after treatment with ondansetron and loratadin were both significant (p=0.001), but the difference between ondansetron and loratadin was not significant (p=0.8).

Conclusion: The results showed that ondansetron was as effective as loratadin in controlling renal itch.

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Background: End stage renal disease or ESRD is a progressive and irreversible deterioration in renal function in which the body’s ability to maintain metabolic and fluid and electrolyte balance fails. Glutathione s-transfrase P1 is member of multigenic family which have essential role in cells as an antioxidant. In this study we investigated the polymorphism of GSTP1 genotypes and oxidative stress in ESRD patients and compare with control subjects to determine the possible relation between polymorphism of this enzyme and ESRD.

Materials and Methods: We select 136 ESRD patients and 137 control cases (without kidney disease). GST P1 polymorphism were determined with PCR-RFLP. Level of MDA was measured by HPLC apparatus.

Results: Genotypes distribution of GSTP1 A/G polymorphism to AA, AG and GG genotypes in control group were 70(51.1%), 56(40.9%) and 11(8%) and In diabetic group 74(55.6%), 50(37.6%) and 9(6.8%), respectively (p=0.744). MDA levels in ESRD patients was higher than control group (p<0.001).

Conclusion: GSTP1 A/G polymorphism between two groups and each groups was not statistically significant with ESRD, probably this enzyme has a protective role in the risk of ESRD.

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Background: Vesicoureteral Reflux (VUR) is the most common urologic anomaly in children. In spite of prescribing prophylactic antibiotics in children with VUR, in some cases breakthrough infection (BTI) occurs while receiving prophylactic antibiotics which may cause pyelonephritis that can ultimately lead in renal scarring.

Materials and Methods: In this discreptive-analytic study, 288 children with primary vesicoureteral reflux under Cotrimoxazole(2mg/kg) treatment have been under supervision for duration of at least one year. Based on the collected data, predictive effect of some factors like gender, mean age of VUR diagnosis, VUR grade, unilateral versus bilateral and presence of abnormal renal scar on the breakthrough infection under prophylactic treatment, were examined.

Results: Breakthrough infection while receiving prophylactic antibiotics was observed among 111(38.54%) patients consisting of 88 girls (79.28%) and 23 boys (20.72%). The moderate to high VUR grades (grade III-V), presence of renal scar and female gender were found to be the important risk factors for BTI. However, no statistically significant relationship between mean age of VUR diagnosis and unilateral versus bilateral VUR with BTI was found.

Conclusion: Results of the current study will help improving parents' and physicians' awareness of the risk factors associated with BTI which may potentially lead to renal damage.

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Background: Renal injury following ischemia - reperfusion (I/R) is still an unavoidable problem in many remedial and medical situations. Portulaca oleracea (PO) has been known for its anti-oxidative effects. Then, the present study aimed to investigate the effect of ethanolic extract of PO (EEPO) on the renal function and antioxidant status after induction of I/R injury in the rat kidney.

Materials and Methods: A total of 30 rats (Wistar) were divided into five groups (n = 6 each). Sham group: underwent laparotomy without I/R, EEPO group: EEPO administered 300 mg/kg then was operated like sham, I/R group: was underwent renal ischemia/reperfusion only, EEPO150+ I/R and AEPO300+ I/R groups: were administered PO 150 and 300 mg/kg then underwent I/R operation. PO extract was administered for 5 days in the relevant groups by gavage. Serum urea and creatinine (Scr), the level of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH) and total antioxidant activity (TAA) were determined. Data were analyzed by ANOVA and post hoc LSD test. P values of 0.05 or less were considered statistically significant.

Results: Induction of I/R and pretreatment with PO extract, increased the level of superoxide dismutase (SOD) in comparison with sham group (p<0.05, p<0.001). There were no significant differences in the levels of MDA, GSH and TAA among different groups. On the other hand, the Scr and serum urea of the I/R and treated groups were elevated compared to the sham group (p<0.001).

Conclusion: Ethanolic extract of PO did not strongly affect the renal antioxidant status and could not prevent the renal injury following I/R.

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Background: Hemodialysis is the most common method of treatment in patients with end-stage renal diseases (ESRD). Given the importance and the role of permeability of hemodialysis membranes in removing the materials and particles, they were divided into two categories Low and High Flux.This study aimed to compare the effects of membranes in removing electrolytes and particles in ESRD patients.

Materials and Methods: In a crossover clinical trial, blood sampling from 30 patients undergoing hemodialysis was done in two sessions of hemodialysis using a Low Flux and High Flux membrane from arterial lines before and after hemodialysis in order to assess and compare the amounts of sodium, potassium, phosphorus, urea and creatinine was taken. Data were analyzed by SPSS 16 software.

Results: The mean age of samples was 47.46±10.74 years and 70% were men and 30% were women. Urea and phosphorus uptake was significantly higher in the high flux membrane (p=0.017)(p=0.006) respectively. Other parameters did not show significant differences between the two filters (p>0.05).

Conclusion: According to the results of research and high flux membrane features, we propose a high flux filter regularly be used in hemodialysis in the absence of specific ban.

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