Nephro-Urology Monthly
Volume:11 Issue: 2, May 2019

Human T-lymphocyte virus type-1 (HTLV-1) infection and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) are endemic in the northeastern population of Iran. Urologic manifestations of the syndrome are different in various stages of HAM and should be evaluated via urodynamic study. The northeastern region of Iran is among the endemic areas; therefore, a comprehensive study is needed to investigate the clinical symptoms and urodynamic findings of these patients. In this study, we examined the clinical features and urodynamic findings of 50 HAM/TSP patients who referred to the urology clinic of Imam Reza Hospital in Mashhad. Data were collected using checklists and analyzed by SPSS software. The significance level of 0.05 was used in all statistical tests. Among 50 patients, 27 (54%) were female. The mean age was 57.56 ± 11 years. The most common clinical findings in patients were urinary frequency (88%), followed by urgency (86%). In addition, the most common urodynamic finding was detrusor overactivity (DO; 78%). Among the studied patients, 62% had pain in the low back or lower extremities, 10% had detrusor sphincter dyssynergia (DSD), 66% had a kind of sensory abnormality, 46% had urinary incontinence, 4% had retention, and 34% had no clinical signs. Regarding neurological symptoms, 36% had rigidity and 28% had an abnormal gait. There was a significant relationship between abnormal gait and DO, DSD, urodynamic incontinence, and decreased urinary compliance (P = 0.01, 0.02, 0.009, and 0.002, respectively). We found that neurologic symptoms and lower urinary tract symptoms (LUTS) do not always synchronize and LUTS may be related to neurologic symptoms. Therefore, urinary and urodynamic evaluations must be performed in the first step for HAM/TSP patients. Among LUTS, only was urinary urgency related to urodynamic findings. Neurologic symptoms were significantly associated with DSD and thus, they can alarm for upper urinary tract damage.

The effectiveness of dialysis or dialysis adequacy is an important standard for evaluating hemodialysis patients. Also, measuring this standard is a crucial goal to all healthcare teams. Inadequate protein intake and catabolism can impact dialysis efficacy. This study aimed to investigate the effect of intradialytic isometric resistance exercise and supplementation with BCAAs on dialysis adequacy in patients undergoing dialysis. A total of 51 patients were randomly divided into three control, exercise and BCAA (EXBCAA), and exercise only (EX) groups and the number of the subjects in each group was 17 patients. The training program consisted of an exercise for arm muscles and another exercise for thigh and core muscles. Exercise sessions were conducted twice a week for two months (24 sessions). Dialysis adequacy variables were kt/v and URR and were measured before the intervention, four weeks after the start of the intervention, and again at eight weeks, which was the end point of the intervention. After the intervention, the kt/V and URR variables presented a significant difference between the two experimental groups vs the control group (P < 0.001). The group that received BCAA and performed isometric resistance exercise indicated the most effective improvements in kt/v (+20%) and URR (+12.5%). Results of this study showed that exercise during hemodialysis can increase dialysis adequacy of hemodialysis patients. Receiving BCAA’s can improve the adequacy even more.

Renal transplantation is one of the best modalities to lengthen the life expectancy of patients with end-stage renal disease (ESRD). However, no sufficient documents exist regarding the effects of renal transplantation on the health-related quality of life (HRQOL) especially in Iranian population. This study aimed to determine the possible influence of renal transplantation in different scales of HRQOL in southern Iran. This Quasi-experimental study was carried out with 120 patient candidate for renal transplantation (Apr 2012 - Jan 2014). Using the general SF-36 questionnaire, HRQOL of the patients 1 week before and 3 months after the transplantation was evaluated. All data were analyzed statistically using descriptive and analytical tests (α = 0.05). Seventy-eight patients (65%) were male. The mean (SD) of the age was 38.92 (13.259) years. HRQOL and its eight scales were significantly different before and after the transplantation (P < 0.001). There was a significant difference between general perception of health and primary school, as well as diploma (P = 0.008). Other demographical factors such as age, gender, marital status and type of donor had no impact on HRQOL, statistically. There was no correlation between HRQOL and the length of facing the disease, except in the subgroup of role limitation due to physical problems (P = 0.01). The study showed that renal transplantation has sufficient credibility in improvement of HRQOL in patients with ESRD. Moreover, continuous enhancement of education level and public knowledge might be as effective as development of medical serving systems in maintaining and achieving greater improvement in HRQOL.

Acute kidney injury (AKI) is a serious complication of treatment in patients receiving Cisplatin. It is not completely inevitable despite all preventive and supportive measures. This study aimed at comparing urine NGAL with other conventional biomarkers (serum Cr, BUN) and GFR in predicting Cisplatin-induced AKI. Overall, 35 eligible patients, who received Cisplatin containing chemotherapy were recruited from a referral center of Tehran, Iran. Baseline and subsequent post Cisplatin treatment levels of BUN, Cr, and Urinary NGAL were measured. Changes in biomarkers versus baseline over time were studied. The ROC curves were constructed to test their ability to predict AKI at different points of time. Of the 35 patients in the study, six (17%) experienced AKI, exclusively limited to stage 1. There were no significant differences between AKI and non-AKI patients regarding age, gender, and type of malignancy (P > 0.05). There were significant differences in day three Cr (P = 0.01), day six Cr (P = 0.03), and day three BUN (P = 0.01) between the two groups. Unadjusted marginal linear regression model suggested a significant difference between two groups, regarding NGAL (P = 0.04) and BUN (P = 0.01) levels over time. The adjusted model only validated BUN (P = 0.04). The area under curve (SD) for urine NGAL measured six hours after Cisplatin treatment was 0.94 (0.04) (P = 0.06). The findings suggest that urine NGAL measured 24 hours after Cisplatin treatment could be a promising candidate biomarker to predict AKI in patients receiving Cisplatin containing chemotherapy.

The prevalence of hypertension and obesity is on the rise in children. Both hypertension and obesity are of the most important factors in the development of cardiovascular diseases. Given the importance of hypertension and obesity in children, this study was conducted to determine the incidence of hypertension and obesity in children and investigate the relationship between these two variables. This cross-sectional study was conducted on 994 children over five years of age admitted to the Children’s Clinic of Amirkabir Hospital in Arak, Iran. Blood pressure was determined by observing the standard blood pressure measurements based on children’s gender, age, and height. The BMI of children was determined based on available charts. Of the 994 children entering the study, 51.1% were male and 48.9% were female. The mean age was 7.49 ± 2.38 years. The prevalence of obesity was 10.5% and the prevalence of hypertension was 7%. Based on BMI, the prevalence of hypertension was 19.2% in obese children and 4.1% in normal-weight children (P < 0.001). The condition of hypertension in children is significantly correlated with their obesity.

Maternal hypertensive disorder is a well-known medical problem during pregnancy and is associated with morbidity and mortality. Out-of-office blood pressure (BP) measurement has been widely used but the importance of detecting white coat hypertension (WCH) is still a topic for debate. The aim of this study was to determine the prevalence of WCH in high-risk pregnant women. We included 56 pregnant women with in-office higher-than-normal BP without previous history of HTN to assess their BP using 24-hour ambulatory blood pressure monitoring (ABPM). The mean age of the participants was 31.61 ± 5.42 years (n = 56) and the majority in the second or third trimesters. Hypertension was detected in 55.4% using 24-hour ABPM. Twenty-five patients (44.6%) had WCH, 60% of whom were in the third trimester. There was a significant difference in the incidence of WCH between women younger than 30 and older individuals (P = 0.041). The mean age was 33.13 ± 5.16 years in patients with true HTN and 29.72 ± 5.22 years in WCH patients (P = 0.018). The prevalence of WCH in pregnancy is noteworthy. Regarding its favorable outcome, this might be a heads-up to avoid unnecessary medication during pregnancy and be concise about defining HTN in this population.

Sodium disorders are one of the most important electrolyte disturbances in children admitted to intensive care unit (ICU). The purpose of this study was to determine the frequency of electrolyte disturbances and the associated factors in pediatric intensive care unit (PICU) patients. All patients hospitalized in PICU of Ali Ebne Abi Talib Hospital during a year since October 2015 considered for the study. Electrolyte disturbances involving; sodium, potassium, calcium and magnesium were identified in PICU. Statistical tests were determined at 5% error level. The prevalence of sodium, calcium and magnesium abnormalities was not significantly different in gender of patients (P > 0.05), but, the prevalence of hypokalemia (9.5% versus 1.7%) and hyperkalemia (37.8% vs. 31.3%) were higher in girls compared with boys. (P = 0.021). The rate of hyponatremia (29.3% vs. 13.1%) and hypernatremia (18.3% vs. 15.9%) in children who had died were significantly higher than in alive children. (P = 0.013). The prevalence of all electrolyte disorders was not significantly different from those of diuretics consumption (P > 0.05). Hyperkalemia though (41% versus 27.3%) was significantly higher in children with diuretic use than in other children. (P = 0.022). The frequency of electrolytes abnormalities in children was not significantly different between diseases (P > 0.05). The study concluded that the frequency of electrolytes was significantly different in deceased children compared to alive children. However, hyperkalemia was significantly higher in children with diuretic use than in other children. Therefore, it is much necessary to measure these electrolytes in course of hospitalization.