Revista de nefrología y terapéutica

El riñón es el principal órgano excretor del cuerpo, responsable de excretar los desechos, sustancias indeseables y tóxicas del cuerpo. Una serie de medicamentos se excretan del cuerpo a través del riñón, por lo que siempre permanece en contacto directo con sustancias de naturaleza aversiva que lo hacen susceptible a la toxicidad y las lesiones, ya que algunas sustancias tienen un efecto nocivo inherente sobre el riñón, como la penicilina y algunos depósitos en los túbulos que perjudican su función, como la gentamicina. Esta es la principal laguna de la medicina occidental, que proporciona un alivio indiscutible al órgano enfermo, pero hace que algunos órganos sanos enfermen. Sin embargo, en el sistema de medicina Unani, muchas hierbas y sus fórmulas se utilizan para curar los trastornos renales desde hace milenios sin ningún efecto secundario. Por lo tanto, en esta revisión se ha intentado discutir sobre los agentes nefroprotectores de uso común del sistema de medicina Unani.

Introduction and objectives: In thrice weekly conventional hemodialysis, dialysate sodium prescription can cause intradialytic plasma sodium shifts, and undesirable symptoms. However, changes in pre-dialysis plasma sodium setpoint are not observed. Whether these clinical observations are observed in quotidian or nocturnal home hemodialysis has not been prospectively evaluated. Methods: A randomized crossover study of conventional, quotidian and nocturnal home hemodialysis patients was performed. Dialysate sodium was personalized 3 mmol/L above (HIGHDIALSOD) or below (LOWDialSOD) the SP, with 100 days for each crossover studies period. Results: Plasma Na+ decreased during hemodialysis in LOWDialSOD study period (136.8 to 135.0 mmol/L, p=0.002). Pre-Na+ SP (137.4 to 136.8 mmol/L, p=0.03) and Pre-Na+ SP slope (0.014 to -0.015 mmol/L/day, p=0.009) decreased from HIGHDialSOD to LOWDialSOD study periods. Conclusions: Personalization of Dial-Na+ to below SP leads to reductions in plasma sodium concentration during hemodialysis, in conventional, quotidian and nocturnal home hemodialysis patients. Furthermore, sodium set point changes in response to Dial-Na+ prescription. This has the potential to lead to adverse outcomes in a patient population that is followed less frequently and stringently than the in-center hemodialysis population.

In Tunisia, data assessing the status of mineral and bone disorders (MBD) among dialysis patients is scarce. In order to address this gap in the literature, we sought to conduct this observational study including 4868 patients from 108 hemodialysis facilities nationwide, aiming to: (i) report parameters of MBD during the first quarter 2006, (ii) determine the levels of compliance with the recommendations of the Kidney Disease Outcome Quality Initiative (K/ DOQI), and (iii) compare these levels of compliance with those of Dialysis Outcomes and Practice Patterns Study (DOPPS). Mean serum phosphorus, calcium, calcium- phosphorus product and intact parathyroid hormone (iPTH) concentrations were respectively 1.74 mmol/L, 2.28 mmol/L, 3.95 mmol²/l² and 254 pg/ml. MBD’s measures were met the K/DOQI’s guidelines in 44.1% of cases for serum phosphorus, 42.5% of cases for serum calcium, 68.6% of the cases for calcium phosphorus product, 20.2% of cases for iPTH and 3.3% of cases for these four parameters taken together. These results were comparable to those observed in the DOPPS study. The most phosphate binder prescribed was calcium carbonate (91.2% of cases) with high average daily dose (superior to 1500 mg in 45.8% of cases). Sevelamer and aluminum salt were prescribed respectively in 0.5% and 0.10% of patients. The only active vitamin D available in Tunisia was alfacalcidol; it was prescribed in 49.7% of patients with a mean weekly dose of 4.04 μg. A calcium dialysate bath of 1.75; 1.50 and 1.25 mmol/L were prescribed respectively in 80.2%, 14.7% and 5.1% of cases. This is the first exhaustive study reporting MBD abnormalities in Tunisia and, to our knowledge, in Africa. A second study was stated in January

Background: Cytomegalovirus (CMV) infection, neutropenia occurrence and mycophenolate (MMF) dose reduction are associated with an increased risk of acute kidney graft rejection. The aim of our retrospective clinical study was to evaluate the association of CMV associated neutropenia with a consequent MMF dose reduction and acute kidney graft rejection. Method: 161 patients transplanted from January 2005 till December 2010, who received anti-CD25 antibodies induction, MMF, calcineurin inhibitor and steroids, were retrospectively analyzed for the incidence of neutropenia (leucocyte count <4.0 x 106/mL with reduced rate of neutrophils to <1.6 x 106/mL in differential white blood cell count, CMV viremia (>150 virus copies/mL detected by polymerase chain reaction), MMF dose modification, granulocyte colony-stimulating factor (G-CSF) therapy and rejection episodes. Results: Neutropenia was detected in 41 (25.5%) patients. It was associated with CMV viremia (p<0.001) but not with CMV prophylactic therapy. MMF dose was reduced due to neutropenia in 29 patients (70.7%) and acute rejection occurred in 6 (14.6%) of them. The average reduction of MMF dose in these patients was 31% of the initial dose. All neutropenic patients with rejection had concomitant CMV infection. There was a trend to positive correlation between MMF reduction and CMV infection or rejection (p=0.06). G-CSF was used in 16 (39.02%) neutropenic patients. No significant correlation was found between G-CSF use and occurrence of acute rejection. Conclusion: CMV infection was important cause of neutropenia that resulted in MMF dose reduction and increased rate of acute graft rejection. G-CSF therapy is an alternative therapeutic approach in neutropenic patients that enables the maintenance of optimal therapeutic dose of MMF and without significant influence on acute rejection occurrence.