N-acetylcysteine (NAC) is used widely and effectively in oral and intravenous forms as a specific antidote for acetaminophen poisoning. Here we report a rare case of iatrogenic NAC overdose following an error in preparation of the solution, and describe its clinical symptoms. Laboratory results and are presented and examined. A 23-year-old alert female patient weighing 65 kg presented to the emergency ward with weakness, lethargy, extreme fatigue, nausea, and dizziness. She had normal arterial blood gas and vital signs. An excessive dosage of NAC over a short period of time can lead to hemolysis, thrombocytopenia, and acute renal failure in patients with normal glucose-6-phosphate dehydrogenase, and finally to death. Considering the similarity between some of the clinical symptoms of acetaminophen overdose and NAC overdose, it is vitally important for the administration phases and checking of the patient’s symptoms to be carried out attentively and cautiously.

Background: Patients in the final stages of renal failure have accelerated inflammation conditions. Inflammation causes progressive kidney damage, faster progression of atherogenesis, chronic malnutrition and increased anemia, resulting in lower life expectancy of patients under dialysis. Statins have pleiotropic effects, because the drug has effects more than just decreasing lipids such as antioxidant effects, changes in endothelial dysfunction, stabilizing the plaque and immune system regulator. Objectives: The aim of the study was to evaluate anti-inflammatory effect of simvastatin (one of the statins) in patients under hemodialysis. Patients and Methods:In this clinical trial study, 40 patients under hemodialysis were studied for 12 weeks. Patients were divided into treatment (25 cases) and control groups (15 cases). The treatment group received a daily dosage of 20 mg of simvastatin, while the control group received no medication. The serum amounts of hs-CRP, IL6, Hb and WBC count were measured and compared at baseline and after 12 weeks. In addition, probable hepatic and muscular complications were studied in patients. Results: At baseline, each of treatment and control groups had similar characteristics. During the study, the average level of CRP decreased in the treatment group (P = 0.04), while it was increased in the control group. The amount of serum IL-6 dropped in the treatment group (P = 0.01); however, it was increased in the control group. In both groups, the level of Hb increased significantly at the end of study in the treatment group (P = 0.007) and the control group (P = 0.016). The average WBC count decreased significantly in the treatment group and the control group (P = 0.003). There was no significant change in hepatic and muscular enzymes in the two groups. Conclusions: End stage renal disease (ESRD) have accelerated inflammatory conditions. Simvastatin clearly lowers the serum levels of CRP and IL-6, and the white blood cell count in dialysis patients. Administering Simvastatin to dialysis patients is safe.

Background: Chronic kidney disease is a persistent disorder in kidney function. This is a progressive disorder characterized by arterial hypertension, glomerular hypertension, proteinuria and some other signs; controlling any of them can reduce the progression of chronic kidney disease. In chronic kidney disease, proteinuria is used as a measure for monitoring nephron injuries and its response to treatment. Angiotensin converting enzyme inhibitors and Angiotensin receptor blockers can reduce the progression of chronic kidney disease by inhibition of Renin-Angiotensin-Aldosterone system and reduction of glomerular pressure and controlling proteinuria. However, none of them can control plasma aldosterone level appropriately. Aldosterone produces Transforming growth factor-b (TGF-b), which induces proliferation of fibroblasts and glomerulosclerosis and accelerates chronic kidney disease. Aldosterone antagonist can increase useful effects of angiotensin-converting-enzyme inhibitor (ACEI) and Angiotensin receptor blockers (ARB) Drugs. Objectives: The study was designed to assess the effects of spironolactone as the aldosterone antagonist combined with ACEI or ARB drugs to reduce proteinuria in chronic kidney disease to prevent its progression. Patients and Methods:This was a semi-experimental without control study. Eighty patients treated for at least two months with ACEI or ARB with uncontrolled proteinuria above 0.9g/dL were treated with 25mg/d spironolactone for two months. 24-hour urine protein and some other variables were measured at the beginning of the study, after two months treatment and one month after discontinuing the treatment. Results: Administration of 25 mg/d spironolactone combined with ACEI or ARB for two months led to mean reduction of 24 h-urine protein from 2796.1 to 1857.4. No hyperkalemia or change in glomerular filtration rate occurred. One month after discontinuation of spironolactone, proteinuria returned to baseline level. Persistence of reduction in proteinuria in patients receiving ARBs was more than those taking ACEIs. Conclusions: Spironolactone combined with ACEIs or ARBs leads to reduction of proteinuria in chronic kidney disease and therefore reduction of progression of the disease.

Introduction: One of the most important causes of erythropoietin-resistant anemia in end-stage renal disease (ESRD) patients is increased levels of inflammatory cytokines. Objectives: In this study pentoxifylline, an anti-inflammatory and anti-cytokine drug, with no significant side effects was used to manage anemia in ESRD patients. Patients and Methods: Thirty-nine ESRD patients with erythropoietin-resistant anemia were assigned to two groups, the treatment and the control groups. In treatment group, 19 patients received erythropoietin, venofer and pentoxifylline for 6 months. Patients in control group received erythropoietin and venofer. Hemoglobin (Hb), hematocrit (Hct), albumin and quantitative C-reactive protein (CRP) were measured at the beginning of the study, monthly and at the end of the study. Results: Hb and Hct were significantly increased in the treatment group (9.33±1.25 g/dL and 28.08±3.88% at baseline; 11.22 ± 1.26 g/dL and 34.02 ± 3.72% at sixth month, P = 0.01), but not in the control group. CRP was significantly decreased in the treatment group but no significant change occurred in the control group. Conclusion: Pentoxifylline is effective in improvement of erythropoietin-resistant anemia in ESRD patients.

Introduction: Proper care of vascular access in hemodialysis patients is important. Catheter-related bloodstream infection (CRBSI), is a life-threatening complication of hemodialysis. Objectives: Sufficient data about microorganisms and their susceptibility to antibiotics in hemodialysis patients is necessary for handling of CRBSI; therefore, this study performed for better management of patients. Patients and Methods: All hemodialysis patients from March 2015 to March 2018 who had cultures of catheter and blood samples were studied. Clinical records of 122 patients were reviewed for variables such as catheter and blood culture microorganism types, antibiotic resistance, age, gender, site, comorbidities, and various clinical signs. Results: Eighty-four cases of catheter cultures were positive for bacteria. Staphylococcus epidermidis was the most common organism (36%) since Staphylococcus aureus was the second one (28%). In some cases, multidrug resistant organisms such as Enterobacter baumannii or methicillin-resistant Staphylococcus aureus (MRSA) organisms were grown. Twenty-one percent of S. aureus organisms were MRSA. No significant association between important diagnostic data (fever, chills or WBC count) and bacteremia were shown. Gender of patients had a significant statistical association with CRBSI. Conclusion: Given the necessity of proper management, physicians must empirically initiate antibiotic therapy as soon as possible, until receiving definite culture results, in hemodialysis patients suspected of bacteremia. In our study, both gram-positive and gram-negative organisms were common. Hence, when initial empirical treatment is indicated, the coverage of both gram positive and gram negative organisms must be considered. Vancomycin or other antibiotics that are effective on MRSA must be included in empirical treatment.