Nephro-Urology Monthly
Volume:5 Issue: 1, Jan 2013

Androgen deprivation therapy (ADT) is an established therapy for metastatic prostate cancer (PC) and some cases of locally advanced and/or localized PC (1). However, concerns have been raised about the cardiovascular side effects of ADT and their impact on the survival of elderly patients with PC (1). Several studies have demonstrated an increased incidence of coronary heart disease, heart failure and acute myocardial infarction in patients on ADT. For instance, in a study on 1015 patients that received ADT (mean duration: 4.1 months), the use of ADT statistically significantly increased the risk of death from cardiovascular causes (HR = 2.6, P = 0.002) (2). In another study on 22816 patients with PC, multivariate analysis revealed that ADT significantly increased cardiovascular morbidity (3). Regardless of the studies that indicate the correlation of ADT with increased cardiovascular risk, surprisingly little is known on the potential mechanisms. ADT increases insulin concentration despite unchanged plasma glucose, which is suggestive of insulin resistance (4). Peripheral resistance to insulin can induce or precipitate type 2 diabetes mellitus (DM) and metabolic syndrome (4). Furthermore, ADT changes the body mass composition as it leads to muscular atrophy and an increase in subcutaneous fat, a situation characterized as “sarcopenic obesity” (5). A study in patients on ADT (mean duration: 3 months) has shown a 4.3% increase in fat mass and a 1.4% decrease in lean body mass (6). Moreover, studies have demonstrated that ADT is associated with dyslipidemias, lower levels of high density lipoprotein and higher levels of triglycerides, total cholesterol and low density lipoprotein concentrations (7). Furthermore, Chen et al. (8) revealed that long-term ADT (mean duration: 2.5 years) significantly decreased the levels of apolipoproteins I and II. Lastly, Nishiyama et al. (9) demonstrated that after 6 months of ADT, body weight, levels of fasting blood sugar, serum total cholesterol, blood urea nitrogen, compensated calcium, inorganic phosphorus, bone-specific alkaline phosphatase, and compensated urinary deoxypyridinoline increased significantly Arterial stiffness increase is another potential mechanism explaining the increased cardiovascular risk in patients on ADT. In a relevant study, arterial stiffness was assessed with pulse-wave analysis (10). After 3 months of ADT, the augmentation index increased from 24% to 29% (P = 0.003), while the timing of wave reflection was reduced from 137 to 129 msec (P = 0.003). Fat mass increased from 20.2 to 21.9 kg (P = 0.008), whereas lean body mass decreased from 63.2 to 61.5 kg (P = 0.016). In a subgroup of patients whose treatment was discontinued after 3 months, the augmentation index decreased from 31% at month to 29% at month 6, in contrast to patients receiving continuous ADT, where the augmentation index remained elevated at month 6 (P = 0.043). These results have been confirmed by other relevant studies (11). In the following diagram (Figure 1) we propose potential mechanisms contributing to the increased cardiovascular risk in patients on ADT. Relevant studies are ongoing and their results are warranted.

The objective of this review is to explore the link between smoking and the development of chronic kidney disease (CKD) in generally healthy populations without pre-existing renal dysfunction such as diabetic nephropathy. Twenty-eight epidemiological studies concerning the renal effects of smoking in the general population were collected from the MEDLINE database and were reviewed for indications of proteinuria and/or the decline of glomerular filtration rate (GFR), and evaluated on the level of evidence and the quality of the study. Sixteen of the 28 studies were cross-sectional in design. Most articles had some weakness in scope, such as the 6 articles which did not fully exclude DM patients from the subjects, the 4 that did not consider the effects of ex-smoking, and the 3 that focused on only a small number of subjects. From these cases, it is difficult to draw firm conclusions. However, proteinuria or microalbuminuria was persistently high in current smokers; as much as 5-8% or 8-15% respectively, which was up to 2 to 3-times the rate of lifelong non-smokers. On the other hand, only 5 studies broader in scope detected any decline of GFR in smokers, while 9 other studies suggested a higher GFR in smokers than in non-smokers. Two good quality studies showed an even a significantly lower risk of a decreased GFR in smokers. These paradoxical CKD markers in smokers, i.e., a higher appearance of proteinuria with a higher GFR, could be a focus for further studies to reveal the underlying reasons for smoking-induced CKD. Workplaces may be an excellent place to study this subject since the long-term changes in renal function of smokers can be observed by collecting data in the annual health check-ups mandated at places of employment.

The renin-angiotensin-aldosterone system (RAAS) plays pivotal roles in the pathogenesis of chronic kidney disease (CKD) progression and its increased complications such as hypertension (HT) and cardiovascular diseases (CVD). Previous studies suggested that aliskiren a direct renin inhibitor, blocks RAAS and may be effective for the management of CKD and its complications. This review focuses on the effects of aliskiren on CKD.

Hepatitis B virus (HBV) infection is much more common in hemodialysis patients than the general population. These patients have an impaired immune response to HBV vaccination; to that end there are certain studies that have evaluated levamisole as an immunomodulator agent improving HBV vaccination response rate in hemodialysis patients.. In the current review، we have assembled all of the results to determine whether lavamisole is of value as an adjuvant to HBV vaccination in hemodialysis patients.. Science Direct (Elsevier)، ProQuest، Springer، MD Consult، BMJ Journals، Pubmed and Wiley were searched for levamisole application to HBV vaccination in hemodialysis patients. All studies revealed a seroconversion response level between levamisole plus HBV vaccine versus HBV vaccine alone.. From 10 relevant studies، 5 studies fulfilled our inclusion criteria. Three of them suggested the significant benefit of adding levamisole to the HBV vaccine to increase augment seroprotection level in hemodialysis patients. Another study reported a decrease in seroprotection level and another study showed no significant difference caused by levamisole administration.. Due to the limited number of studies evaluated، it is challenging to perform a definite decision about routinely administering levamisole in addition to the HBV vaccine for all hemodialysis patients. However، it does seem reasonable to recommend administration of levamisole for impaired immune response patients.

When using brain dead donors for organ donation, assessment of kidney function before the procedure is essential.. It would be ideal to find an early marker of viability of donor kidneys that is more accurate than creatinine..Patients and The present study was conducted from March of 2011 to March of 2012, included 52 deceased donors. Serum and urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) and creatinine were measured at 0, 2, 4, 8, 12 and 18 hours after their admission to the ICU of our organ procurement unit (OPU). Other routine laboratory tests of hemglobin, blood glucose and lipid profile were performed as well.. There were 31 males and 21 females with the mean age of 29.7 ± 14.3 (6-58) years. Thirty one patients became brain dead due to car accidents. The mean time of admission time before harvest was 12.6 ± 5.8 (3-30) hours. We did not discover any correlation of serum creatinine with serum or urinary NGAL at any time before the organ harvesting. However, serum NGAL level measurement 2 hours after admission correlated significantly with other hours'' measurements (4, 6, 8 hours, r > 0.9; P < 0.001).. The serum NGAL level, especially at 2 hours after admission to the ICU, should be evaluated with kidney function after transplantation to get the accurate predictive value.

Several studies have been carried out to evaluate the effects of dialysis on O2 saturation. While the dialysis procedure may lead to hypoxia under different circumstances، there are few studies available on the effects of membrane type on O2 saturation in these patients.. This study was to appraise the effects of high and low flux membrane on pulse oxymetery in dialysis patients.. Patients and In a cross-sectional evaluation، 43 hemodialysis patients without pulmonary disease were enrolled. Of this group، dialysis was performed by low and high flux membranes، and pulse oxymetery was applied before and after the procedures.. Mean age of the patients was 56. 34 years. Of these patients، 23 (53. 5%) and 20 (46. 5%) were women and men، respectively. Type of membrane (high flux vs. low flux) did not show any significant effect on pulse oxymetery results (P > 0. 05).. Due to the lack of a significant difference in pulse oxymetery and creation of hypoxia between two types of membranes in hemodialysis patients، as well as the high cost of high flux membrane as compared to the low flux membrane، we do not suggest the use of high flux membrane in dialysis..

Pulmonary Tuberculosis (PTB) is one of the common diseases with high prevalence of mortality and morbidity in developing countries. Various complications have been reported along with PTB. The subclinical electrolyte imbalances are customary in cases with PTB.. The aim of this study was the evaluation of patients with PTB and hyponatremia..Patients and We evaluated patients with diagnosis of secondary PTB who have been admitted to Baqiyatallah hospital, Tehran, Iran from 2005 till 2010. The diagnosis of PTB was based on the appearance of acid fast bacilli in sputum smears or sputum cultures, without any evidence of miliary TB. Demographic and laboratory characteristics relative to electrolytes were recorded according inclusion and exclusion criteria.. The mean age was 59.22 ± 20.57 years and 91 (45.5%) patients were male. The mean serum sodium concentration was 134.54 ± 4.95 mmol/L and more than half of subjects (51%) have shown hyponatremia. The mean age difference between hyponatremic and eunatremic groups was statistically significant (61.95 versus 56.02 years, respectively) (P = 0.047). No significant relationship was found between hyponatremia and gender, anti-TB medications and co-morbidity conditions.. In this study, an older age was suggested as an important predisposing factor for hyponatremia in patients with PTB which had been observed as less of a determinant. We recommend further evaluations for hyponatremia in patients presenting with PTB, particularly for those who are older.

Multiple renal arteries in kidney grafts have been associated with an increased rate of vascular and urologic complications. Our objective is to compare the outcome of transplanted patients who receive a single pedicle kidney with those who receive a multiple arterial graft.. To find our the differences in the outcome and complications in patients undergoing kidney transplantation with one single artery or with multiple arteries..Patients and We analyzed 147 kidney transplantations, (all performed in our hospital over a 3 year period). population divided into two groups: group A for those who presented with only one renal artery, or group B for those with more than one renal artery. Homogeneous vascular reconstructions and implantation rules were applied in all patients. We compared the rates of renal failure between the two groups, urinary and vascular complications, patient and graft survivals and the levels of creatinine clearance during the first year of post-transplantation.. No significant differences were found between the two groups regarding to the values analyzed.. As many other authors, we do believe that the presence of multiple renal arteries in kidney grafts should not be considered as a predictive factor of transplantation failure..

Dialysis vascular access complications are considered as significant causes of morbidity in chronic hemodialysis patients.. The aim of the present study was a comparison of axillary loop and straight grafts patency and its complications in hemodialysis access..Patients and In this cohort study conducted at Shahid Beheshti Medical University, 77 patients who underwent placement of loop or straight access grafts were included. Demographics, primary and secondary patency rates and complications like thrombosis, infection, bleeding, steal syndrome and other complications were compared in these two groups. The collected data was analyzed by chi-square test, t-test, and logistic regression.. Primary patency rate in straight and loop groups after 1 month were 88.9% and 92.3% respectively (P = 0.721), and after 24 months were 31% and 55.5% respectively (P = 0.058). Secondary patency rate in straight and loop groups after 3 months were 75.6% and 92.3% respectively (P = 0.189), and after 24 months were 37.9% and 66.7% respectively (P = 0.044). The frequency of complications were the same among two methods of graft replacement and mal incidence of thrombosis, infection, delayed infection, pseudoaneurysm formation and steal syndrome occurrence ultimate graft failure and venous hypertension were not significantly different (P > 0.05).. Polytetrafluorethylene (PTFE) vascular graft seems to be an appropriate vascular access and is a promising alternative when upper extremity arteriovenous fistulas cannot be constructed. Additionally, there was no significant difference between the two groups for complications and early patency, but late patency was improved in loop group. More study is necessary for a conclusive assessment.

Nephrolithiasis is a widespread multifactorial disorder. Constitutional, environmental and genetic factors play a role in stone formation. Although important advances have been made in understanding the pathophysiology of stone formation, none of the many theories have given a satisfactory explanation of this process.. The objective of study was to evaluate the probable relationship between cigarette smoking and nephrolitiasis in adult men..Patients and A total of 102 cases diagnosed with nepholithiasis and 121 age-matched healthy controls were recruited from June 2010 to September 2011. Smoking status and resultant data was obtained from both groups.. Twenty seven (26.5%) of the patients with stones and eighteen (14.9%) of the control group were current cigarette smokers. Our findings showed that smoking significantly increases the risk of nepholithiasis (OR = 2.06, 95% CI: 1.06-4.01, P = 0.034). There was no significant difference in the number of cigarettes smoked (P = 0.830) and years of smoking (P = 0.536) between subjects with and without stones (P = 0.536).. This study suggests that cigarette smoking might be an independent risk factor for the development of nephrolithiasis.

Primary ureteral neoplasms are very rare and its prevalence is less than 1% of all genitourinary neoplasms. We report a symptomatic giant ureteral fibro epithelial polyp in adult women presenting as a bladder mass which was resected ureteroscopically and reported at the first time from Iran. Cystoscopy is growing use in the treatment of urinary tract lesions Cystoscopy can be used in large lesions in centers with experience rather than open surgery..

Although bladder leiomyoma is rare, this is the most frequent nonepithelial benign tumor of the bladder. Symptoms and treatment depend on location and size of the lesion as well. The optional treatment is a total enucleation or partial cystectomy, although in biopsy proved cases watchful waiting is an option, surgery should be considered as the tumor grows or symptoms are observed. The etiology of bladder leiomyoma is unknown. Uterine leiomyoma is known to be estrogen responsive. The premenopausal women are prevalent in the fourth decade.