Nephro-Urology Monthly
Volume:9 Issue: 2, Mar 2017

Context: As the most common renal malignancy in childhood, Wilms’ tumor (WT) is responsible for nearly 7% of all childhood cancers, with an annual incidence rate of about 7 to 10 cases per million in children younger than 15 years of age. Wilms’ tumor is not confined to children and it can also involve older children and even adults. Like other primary renal cancers, such as renal cell carcinoma, WT can develop unique features of ureteric, intra-caval or intra-cardiac extension; their incidences are approximately 2%, 4% to 10%, and 1%, respectively. Treatment strategies from various oncology research groups are somehow different with similar results at the end.
This study aimed at reviewing the current literature on the diagnosis, staging, and different treatment strategies for Wilms’ tumor with either ureteral or intravascular extension.
Evidence Acquisition: In this article, we reviewed the current literature about staging, diagnosis, and management strategies for WT, through a randomized clinical trial, which focused on this matter. The Medline database (through PubMed) and Cochrane Library was searched for the following key words: Wilms’ tumor, ureteral extension of Wilms’ tumor, and intravascular extension of Wilms’ tumor with no time limit for studies documenting the diagnosis, staging, and treatment strategies.

Chronic kidney disease (CKD) is a prevalent, progressive, and treatable disease. However, lack of enough data about its prevalence in Iran is a major obstacle for its early detection. In order to determine the prevalence of the disease in the country, it is necessary to conduct epidemiologic studies especially on populations with ethnic diversity; hence, this study aimed at determining the prevalence of CKD and its predisposing factors in an adult population aged 15 to 75 years old in Kerman city.
This cross-sectional study was conducted on 988 adults aged 15 to 75 years in Kerman city, during year 2010. We collected data on the status of hypertension (HTN) and Diabetes Mellitus (DM) in all participants. Moreover, height, weight, and blood pressure of all participants were measured and a blood sample was taken for laboratory tests. In addition, a morning urine sample was taken to detect microalbuminuria and measure protein, and creatinine. Patients’ glomerular filtration rate (GFR) was calculated using modification of diet in renal disease (MDRD) formula, and the stage of the chronic kidney disease (CKD) was determined.
Of all the participants, 58% were female and the mean age (SD) of participants was 45 ± 16 years. Considering participants’ body mass index (BMI), 37% were overweight and 18% were obese. The prevalence of HTN and DM were 20% and 14%, respectively. Mean GFR (SD) was 67 ± 20 mL/min/1.73 m2. Overall, 91% of the participants were affected by some degree of CKD (stage 1:5%; stage 2: 55.1%; stage 3: 30.5%; stage 4: 0.4%). Prevalence of CKD that was defined through GFR 0.05).
The findings of the present study showed that 91% of the adult population living in Kerman city was affected by some degrees of CKD and more than one-third were at stages 3 or 4. Prevalence of CKD that was defined through GFR

Urodynamic studies (UDS) is a simple non-invasive test to assess lower urinary tract function but it may be affected by several factors includes age, sex, voiding volume and voiding position. These interventional parameters become more highlighted while performing UDS in children whose emotional stress control and coping with unfamiliar situation is more difficult.
Seventy six primary school age healthy children underwent screening uroflowmetry in different voiding positions voluntarily. Cases with urinary symptoms, other coexisting diseases, voiding volume less than 20cc or staccato voiding curve were excluded. Washrooms were designed in both western and eastern styles. UDS indexes were compared regarding voiding habits.
Comparison of uroflowmetric indexes between different genders and voiding positions showed differences which were not statistically significant but considering the voiding habits, uroflowmetric indexes were significantly different in familiar compare to unfamiliar voiding position. Q-Max was lower and time to Q-Max and micturition time were longer in unfamiliar voiding position.
Urodynamic studies in children should be performed in preferred voiding position for each kid considering the culture and voiding habits. Unfamiliar voiding position may turn the uroflowmetry to a stressful experience for child that make him uncooperative and cause misleading results.

Low-molecular-weight heparin (LMWH) has been suggested as an effective and safe anticoagulant for hemodialysis. The aim of our study was to investigate the effects of LMWH including minor bleeding, clotting formation in the extracorporeal dialysis circuit and their effect on the lipid profile in comparison with heparin.
This randomized, crossover study with parallel design was conducted in 45 patients who required maintenance hemodialysis due to end-stage renal failure. Four patients with known bleeding disorders, receiving anticoagulant drugs and receiving drugs which could affect heparin activity were excluded. All patients were randomly assigned to receive either enoxaparin sodium (0.7 mg/kg) or standard heparin for a duration of 12 weeks, after which patients were crossed over to another therapy for a further 12 weeks. Enoxaparin sodium was administered 5 minutes before dialysis, injected into the arterial line pre- dialyser and heparin was administered 50 U/kg intravenously into the pre- dialyser arterial line followed by a maintenance dose of 1000 U per hour.
The mean age of the study population was of 65.18 (SD = 12.15) years. From these patients 22 (53%) were male and 19 (47%) were female. At the end of the first study phase, minor bleeding in patients receiving enoxaparin with dose of 0.25 mg/kg was significantly decreased in comparison to the patients receiving heparin (P: 0.03), although vascular compression time did not significantly differ between the heparin and enoxaparin groups. At the end of the second study phase, the enoxaparin group showed a significant increase in minor bleeding in comparison with the heparin group (P: 0. 04). In the enoxaparin arm, recurrent blood oozing from puncture sites led to the idea to reduce the dose of enoxaparin. After enoxaparin dose reduction, the frequency of minor bleeding decreased to 10% (from 19% to 10%) (P: 0.01). Vascular compression time was not statistically different in heparin and enoxaparin at the end of study (P: 0.1). There were no significant changes in serum lipids with either anticoagulant neither at the end of the 12th week nor at the end of the 24th week.
This study suggests that a single-dose of enoxaparin is an effective and convenient alternative to standard heparin. The recommended dose of this study in Iranian patients is 0.25 mg/kg.

Sleep disturbances are common among uremic patients. However, limited data are available on predictors of the quality of sleep in this population.
This study aimed to assess the quality of sleep in patients undergoing hemodialysis and investigate its predictors.
In this cross-sectional study, 197 patients on maintenance hemodialysis were consecutively included from three medical centers in Shiraz, southern Iran. They completed the Pittsburgh sleep quality index. Serum calcium, phosphorus, and hemoglobin levels were checked. We also assessed the neck circumference, dialysis shift, dialysis plan, diabetes history, body mass index (BMI), age, and sex.
From a total of 197 patients, 124 cases were men. The mean age of the patients was 54.46 ± 14.84 years. Poor quality of sleep was frequent in 90.86% of the cases. Age, BMI, a history of diabetes mellitus and the product of calcium and phosphorus were independent factors affecting the quality of sleep. Serum calcium and phosphorus levels, hemoglobin, sex, dialysis shift, dialysis plan, neck circumference and dialysis quality showed to have no significant effect on the quality of sleep.
Poor quality of sleep is very frequent in patients on maintenance hemodialysis. Further studies are required for better understanding of risk factors associated with the poor quality of sleep to find possible treatments for these patients.

Medications, alternative and complementary treatments for type-III chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) are used frequently. The aim of this article is to define thermobalancing therapy as an independent treatment for internal diseases, such as CP/CPPS.
The effect of thermobalancing therapy (TT) by using Dr. Allen’s therapeutic device-(DATD) on patients with CP/CPPS was investigated. National institute of health chronic prostatitis symptom index (NIH-CPSI) scores, prostatic volume (PV), and maximum urinary flow rate (Qmax) were measured in one group of 45 patients who underwent TT and a control group that did not have TT. These all parameters were compared between groups.
No significant difference was found at baseline evaluation in treatment and control groups with regard to age, NIH-CPSI score, PV or Qmax. In the treatment group pain score decreased and quality of life (QoL) improved significantly, whereas in the control group no changes. TT reduced PV and increased Qmax significantly, whereas in the control group TT did not elicit significant changes in PV and Qmax.
The study has explored that TT with DATD as monotherapy for CP/CPPS patients: (i) reduces pain dramatically and improves QoL; (ii) reduces PV and increases Qmax. None of the patients who received TT suffered side effects and the cost of TT compares favourably with the cost of conventional treatment. Thus, TT could be recommended as a new independent treatment for CP/CPPS.

Secondary Hyperparathyroidism (sHPT) is an important feature of chronic renal failure and contributes to the development of renal osteodystrophy. This study was carried out to assess 25(OH)D status and its effect on sHPT in patients on hemodialysis (HD).
A prospective experimental trial of 180 HD patients (F: 81, M: 99, age > 14year) participated in the study. At base line, levels of 25(OH)D, intact Parathyroid Hormone (iPTH), Calcium (Ca), Phosphorous (P), Alkaline phosphatase (Alk p), and albumin of serum were measured. Patients with 25(OH)D deficiency ( 300 pg/mL.
Serum 25(OH)D levels were deficient in 87.8% (n: 158) of subjects, and normal in 12.2% (n: 22). The prevalence of sHPT, according to 25(OH)D levels, was 71.5% (n: 113)( These findings showed that 25(OH)D insufficiency was highly prevalent in HD cases and higher amount of 25(OH)D levels prevent sHPT.