Nephro-Urology Monthly
Volume:9 Issue: 4, Jul 2017

Context: An immunosuppressive drug, Cyclosporine (CsA), has been commonly used in kidney transplants. A safe dosing of CsA often causes nephrotoxity, bone marrow toxicity, and infection. Pharmacokinetic characteristics of CsA and CsA marker relation to the immune suppression have not been completely described in clinical practices yet.
This review summarizes our achievements on pharmacokinetic and CsA level Marker in kidney transplant patients.
Search methods and Selection criteria: A literature review was done using the National Center for Biotechnology Information’s Pubmed Medline, Ovid Medline and Embase, and Iranian registries (Iranmedex, SID, MagIran, and IranDoc). Titles and abstracts were then reviewed to select studies based upon the predefined inclusion criteria. Our study defined a population of adult solid organ transplant recipients receiving the cyclosporine that Cyclosporine monitoring was done.
Data Collection and Analysis: Two reviewers independently appraised the quality of each trial and extracted the data from the included trials.
CsA pharmacokinetics is very different between kidney transplant recipients, in order to CsA profiling, no pharmacodynamic tools has been confirmed yet in clinical practices and the best way to individualize calcineurin inhibitor therapy is still a controversial issue. C0 levels do not exactly predict the CsA level or rejection risk, patient monitored by C2 levels have upper doses of CsA and have a lower frequency of early acute allograft rejection than patients profiled with C0 and although CA is highly heterogeneous closely post-transplant and seems to be unhelpful early after post-transplant it is more favorable after first months after.
Establishing a biological CsA marker may be helpful in clinical decisions on the dose. It seemed to be logical that we should re-inspect the possibility of using them as a supplementary tool towards better therapeutic drug monitoring of cyclosporine or it needs to be reevaluated and needs to find a new target for a therapeutic plan in kidney transplant patients.

Hypomagnesemia is a usual finding in patients admitted to intensive care unit (ICU) that is usually the result of magnesium (Mg) loss from renal or gastrointestinal (GI) tracts.
The current study aimed at evaluating the relationship between the level of Mg in serum and outcome of patients admitted to ICU.
The current cross sectional, descriptive study was performed on patients admitted to ICU for 1 year. All of the patients stayed at least 2 days in ICU. Data on the underlying disease were collected based on a check list. All patients were followed-up until the discharge time. Parametric and non-parametric tests were used for the statistical analyses using SPSS software ver. 18.0.
One hundred one patients (52 males and 49 females) were enrolled in the current study. Most of the underlying diseases in patients were pulmonary (31.7%) and renal (24.8%) diseases. Hypomagnesemia and hypermagnesemia were observed in 31.7% and 17.8% of the patients, respectively. Hypomagnesemia was mostly observed in patients with gastrointestinal (50%) and renal diseases (36%). Among the 101 patients, 71 (70.3%) cases died and 30 (29.7%) cases were discharged from the hospital. Hypomagnesaemia was observed in 28.1% of dead patients and 40% of the discharged ones. There was no significant correlation between the serum level of Mg and patients outcome.
Further studies should be conducted on the total serum Mg and ionized level of Mg in serum, and their correlation with the outcome of patients admitted to ICU.

The number of patients with overweight and obesity requiring renal transplant in the past 2 decades increased considerably.
The current study aimed at evaluating the effect of body mass index (BMI) on graft and patients survival rate.
Design: In the current retrospective, cross sectional study, transplant recipients were divided into 3 groups based on their BMI: group 1 (BMI 25 kg/m2). Kaplan-Meier formula was used to calculate the patient survival rate, log-rank test to compare the survival curves, analysis of variance (ANOVA) to compare continuous variables, and the Chi-square test to compare the classified data. Statistical analysis was performed by SPSS version 19. P values ≤ 0.05 were considered significant.
The 5-year follow-up on patients’ survival rate in groups 1, 2, and 3 was 91% ± 0.03%, 91% ± 0.01%, and 80 ± 0.03%, respectively. Also, the 5-year graft survival rate in groups 1, 2, and 3 was 90% ± 0.02%, 85% ± 0.02%, and 76 ± 0.03%, respectively. There were significant differences between BMI status and gender of the recipients (P value = 0.003) and those of the donors (P value = 0.003), type of kidney in donors (P value = 0.001), type of dialysis in recipient (P value = 0.001), history of type 2 diabetes mellitus in recipient (P value = 0.001), recipient age (P value = 0.001), duration of hospitalization (P = 0.026), cholesterol levels after 1 year (P value = 0.001), and BMI status of the recipient.
The results also indicated that the graft survival rate of the recipients was not statistically different in terms of BMI; thus, the results suggested that to allow of counting in patients included overweight and obesity kidney transplantation as appropriate action treatment.

Patients on hemodialysis (HD) generally display a significant decrease in the quality of life owing to comorbidities, malnutrition, and inflammation.
In this multicenter prospective study, the SF36 (short form with 36 questions scored between 0 and 100) and relevant demographic data and comorbidities (charlson comorbidity index); nutritional factors, and C-reactive protein (CRP) were evaluated in 416 HD patients in September 2012. Hospitalization and mortality were assessed in a median of a 28 month follow-up.
The SF36 score in survived patients was 53.6 ± 19.3 versus 41.6 ± 22.4 in the non-survived patients (P 3.60 - 3.85, > 3.85 - 4.00, > 4.00 - 4.20, > 4.20 (reference) g/dL was respectively 3.69 (1.98 - 6.89), 2.08 (1.10 - 3.94), 1.91 (0.97 - 3.85), 1.10 (0.76 - 1.49). Serum albumin revealed a strong association with mortality such that hazard ratio for every 1 g/dL decrease in serum albumin was 6.28 (95% CI: 3.80 - 10.42; P

Children with pollakiuria have extraordinary daytime urinary frequency, which means urination every 15 to 20 minutes per day, without nocturnal enuresis, urinary incontinence, dysuria, and UTIs. This can be associated with developmental disorders. Therefore, this study aimed at evaluating the effect of Pollakiuria on developmental disorders.
A total of 224 individuals were included in this study. The age range was 5 to 7 years old and 70 patients with Pollakiuria were allocated to the case group and 154 healthy individuals were included in the control group. Height, weight, and Body Mass Index (BMI) were measured and were compatible with gender and age. The following information was also recorded, personal and social development, problem solving, fine motor, gross motor, communication, defining words, understanding of contradictory words, counting numbers, names of colors, copying forms of □ and Δ, and walking on toes, which were obtained by the ages and stages questionnaires (ASQ) and nelson development table.
From a total of 224 children, factor expressing growth and development condition in the case group was significantly less than the control group (P = 0.001).
Development indicators, according to ages and stages questionnaires, in healthy children had a better status compared to children with Pollakiuria.

Autosomal dominant polycystic kidney disease (ADPKD) is a heterogeneous disorder. Two known loci, including PKD1 (16p13.3) and PKD2 (4q21), as well as a third locus that is not clearly identified, cause ADPKD.
The aim of this study was to assess the genetic linkage of 4 linked microsatellite markers of PKD genes (PKD1 and PKD2) to ADPKD for genetic screening of familiar PKD patients in Yazd.
This familial case-control study was conducted among 18 families. The linkage analysis was performed using 2 pairs of polymorphic microsatellite markers that are closely linked to the PKD1 gene (16AC2.5 and KG8) and 2 other pairs closely linked to the PKD2 gene (D4S231 and D4S423). These markers were detected through PCR of tandem repeats method and polyacrylamide gel electrophoresis.
The disease was linked to PKD1 about 77.8%, PKD2 16.7% of the families, and to neither gene in 5.5%, according to LOD scores and allele segregation analysis. It also found relatively high heterozygosity and polymorphism information contents (PIC) values for 3 markers including 16AC2.5 (PIC: 0.798) for PKD1 gene and D4S423 (PIC: 0.807) as well as D4S231 (PIC: 0.741) for PKD2 gene. However, it seems that KG8 marker has no significant linkage to the PKD1 gene (PIC: 0.329) among Yazd PKD patients.
These results show similarity to another report from Iranian families and according to these similar results, it seems that 16AC2.5 and D4S423 markers would provide an improved framework for genetic screening of ADPKD patients among familiar PKD patients in Yazd.

The study aimed to compare tubeless, totally tubeless, and standard percutaneous nephrolithotomy (PNL) in a tertiary center with selected patient population.
Between September 2013 and March 2015, percutaneous nephrolithotomy was performed on 216 patients in our center. Patients without massive bleeding, calyceal perforation, and residual fragments smaller than 4 mm were enrolled in this study. The patients were divided into 3 groups. In the first group (n = 68), we placed nephrostomy and kept ureteral catheter for 24 hours (the standard group). In second the group (n = 69), no nephrostomy was inserted and ureteral catheter was removed in the operation room (the totally tubeless group) and in the third group (n = 79), no nephrostomy catheter was placed but antegrade DJ stent was inserted intraoperatively (the tubeless group). Three groups were compared with respect to age, analgesic requirement, BMI, length of stay, pain, and stone size.
No significant differences were found in the mean stone size, operation time, transfusion rates, and hemoglobin level change between the groups. However, hospitalization time, the amount of narcotic usage, and pain were significantly lower in the second group compared to the other groups (P

This study aimed at presenting a case of testis dermoid tumor with false positive meta-iodobenzyl-guanidine (MIBG) scan.
Case Report: A 16-year-old male was referred to the urology service with bilateral testicular tumor. Testis carcinoid tumor was diagnosed after right radical orchiectomy. Although the MIBG scan was positive in left hemiscrotum before left sided operation, the left side pathology reported testis dermoid cyst.
Meta-Iodobenzyl-Guanidine can be absorbed by adipose tissue, one of the components of dermoid cysts. This phenomenon can result in false positivity of this scan in these cases. False negative MIBG scan is not uncommon in carcinoid tumors, however, false positive answers should not be neglected in planning treatment.

Anaplastic sarcoma of the kidney is an extremely rare tumor, mostly observed in pediatric age group. This tumor is the counterpart of embryonal or undifferentiated sarcoma of the liver and pleuropulmonary blastoma of lung. To the best of the authors’ knowledge, only 26 cases were reported in the English literature and the current case, a 3-year-old male, was the 27th reported case with this tumor. It is very important to differentiate this tumor from the Wilm tumor as well as renal cell carcinoma, as they were preoperative diagnosed in all of the reported cases.

Penile hair tourniquet syndrome (PHTS) is a rare clinical condition characterized by progressive penile strangulation caused by a piece of hair curled around sulcus corona. This clinical condition may result in some clinical and urgent complications including ischemia and gangrene of glans penis, urethra-cutaneous fistulae, and urethral transection. The case report is about a four year and six month old circumcised boy with a hair coil penile strangulation caused by strands of hair being wrapped around the sulcus corona.