kidney disease

World Kidney Day 2025 represents an essential opportunity to address urgent issues surrounding kidney health. Its aims focus on educating the public and healthcare professionals about the significance of kidney disease prevention, promoting early detection through screening, and advocating for equitable access to healthcare resources.

End-stage renal disease (ESRD) is a pervasive global health challenge with high mortality rates. This prospective study aimed to identify medical factors influencing mortality in ESRD patients.

Data from 149 ESRD patients registered at Imam Khomeini hospital in Kermanshah were analyzed. Only patients with a minimum of one-year follow-up were included. Univariate and multiple regression analyses were employed, and model evaluation utilized indicators such as the area under the receiver operating characteristic (ROC) curve, sensitivity, and specificity.

Among 149 ESRD patients, 88 (59.1%) were male, and 37 (24.7%) experienced mortality. The average age of deceased patients was 63.59±15.74 years. Chronic glomerulonephritis was the underlying cause in 72 (48.3%) participants. Multiple regression revealed that age, diabetes, and a history of heart failure significantly correlated with mortality. ESRD patients with diabetes faced a 2.47-fold increased risk of death (95% confidence interval: 1.10 - 5.55). The model exhibited an area under the curve (AUC) of 0.70, with sensitivity and specificity of 51.35% and 75%, respectively.

Given the chronic nature of ESRD and elevated mortality, particularly among diabetic patients, intensified monitoring efforts are crucial for the prevention and management of diabetes in this population.

Enterococcus faecalis is known as common pathogen for endodontic infections and cause secondary and refractory pulp periapical periodontitis. The bacteria can opportunistically colonize periodontal pockets and presents a possibility of infection developing in other organs. This research will investigate the dissemination of E. faecalis from the gingival tissue to the heart and kidney.

Three groups were formed, consisting of twelve male Sprague Dawley rats: a control group des- ignated as 0-day, and experimental groups labeled as 7-days and 14-days. Periodontitis induced by concurrent infection with sterile wire 0.2 mm insertion and E. faecalis inoculation is performed into the gingival sulcus located between the maxillary right 1st and 2nd molar teeth area. After euthanasia, tissue samples around the maxillary gingiva, maxillary jaw samples, kid- ney and heart tissues were obtained for quantitative Real-Time PCR assay and histopathological analysis.

Results showed at 7-days, there was an upregulation of E. faecalis gene expression in the gingiva, heart, and kidney samples as well as infiltration of the inflammatory cells at 7-days post induction, which consequently decreased at 14-days.

Thus, the study suggests dissemination of E. faecalis from gingival tissue to the heart, kidney which could be probable link between periodontal disease, heart, and kidney disease.

The number of patients affected by Chronic Kidney Disease(ckd) grows every year. Adherence to nutritional restrictions can affect the adequacy of dialysis treatment and also it is heavily dependent on suitable and sufficient health literacy level of patients undergoing dialysis. Considering the progressive increase of dialysis patients in Abadan, present research was performed to investigate the relationship between health literacy and adherence to diet and adequacy of dialysis. The present research is a descriptive- cross-sectional study performed on 207 patients referring to the dialysis ward of the hospitals covered by Abadan University of Medical Sciences via regular systematic randomized method. Data collection was performed using three questionnaires including demographic information, Health Literacy for Iranian Adults (HELIA), ESRD-AQ, and KT/V investigation Data analysis was performed using descriptive and inferential statistical tests plus logistic regression model in SPSS 27.  Out of 207 patients examined, 28.50% of patients had poor adherence while 71.50% showed strong adherence. Among patients with poor adherence, 58.2% had low health literacy, 40% average and 1.8% high. Furthermore, logistic regression model showed that by increasing in the health literacy level of the patients, the chance of adherence would grow by 6.3 times, which was statistically significant(CI= 3.13).. However, no significant relationship was found between level of health literacy and adequacy of dialysis (CI=1.73). Considering the significant relationship between health literacy and adherence to the diet, it becomes important to make attempts for showing the significance of enhancing the health literacy of patients undergoing dialysis in order to enhance adherence to the diet and thus support the success of dialysis treatment method and enhance the general care of these patients.

It is now hypothesized that the Ambulatory Blood Pressure Measurement (ABPM) method in determining and controlling blood pressure and renal disease-related cardiac defects in children with renal impairment can be more applicable. We aimed to compare the mean blood pressure measured by the ABPM method with blood pressure measured by the auscultation method in determining cardiovascular complications by measuring left ventricular mass index (LVMI) in children with chronic kidney disease.
This cross-sectional study was performed on 40 children suffering from chronic kidney disease referred to Mofid Children Hospital in Tehran between 2019 and 2021. Each child was evaluated during the first 24 hours, every 20 minutes during the day, and every 30 minutes during the night, and blood pressure was assessed by the ABPM method and every 3 hours by the auscultation method. Patients also underwent echocardiography to determine LVMI.
Based on the assessment by auscultation method, 47.0% of children suffered from systolic hypertension, and 40.0% had diastolic hypertension. In total, 50% were hypertensive. According to ABPM blood pressure data, 23 patients (57%) had systolic hypertension and 24 patients (60%) had diastolic hypertension. In total, 16 patients (40%) had normal blood pressure and 24 patients (60%) had hypertension by the ABPM method. Also, according to ABPM measurement, 10 patients (25%) suffered from masked hypertension, and 6 patients (15%) from white-coat hypertension. There was a significant association between LVMI and the blood pressures assessed by the ABPM method.
Auscultation blood pressure measurement alone may not be sufficient to diagnose hypertension in patients with chronic kidney disease. It should be used in conjunction with the ABPM method.

 Renal transplantation plays an essential role in the quality of life of patients with end-stage renal disease. At least 12% of the renal patients receiving transplantations show graft rejection. One of the methods used to diagnose renal transplantation rejection is renal allograft biopsy. This procedure is associated with some risks such as bleeding and arteriovenous fistula formation. In this study, we applied a bioinformatics approach to identify serum markers for graft rejection in patients receiving a renal transplantation.

 Transcriptomic data were first retrieved from the blood of renal transplantation rejection patients using the GEO database. The data were then used to construct the protein-protein interaction and gene regulatory networks using Cytoscape software. Next, network analysis was performed to identify hub-bottlenecks, and key blood markers involved in renal graft rejection. Lastly, the gene ontology and functional pathways related to hub-bottlenecks were detected using PANTHER and DAVID servers.

 In PPIN and GRN, SYNCRIP, SQSTM1, GRAMD1A, FAM104A, ND2, TPGS2, ZNF652, RORA, and MALAT1 were the identified critical genes. In GRN, miR-155, miR17, miR146b, miR-200 family, and GATA2 were the factors that regulated critical genes. The MAPK, neurotrophin, and TNF signaling pathways, IL-17, and human cytomegalovirus infection, human papillomavirus infection, and shigellosis were identified as significant pathways involved in graft rejection.

 The above-mentioned genes can be used as diagnostic and therapeutic serum markers of transplantation rejection in renal patients.  The newly predicted biomarkers and pathways require further studies.

The prevalence of glomerular diseases, as the leading cause of chronic kidney disease, is increasing. Renal biopsy is still the gold standard for diagnosis of the most kidney disorders. Data on prevalence of the biopsy-proven kidney diseases in Iran is limited and none of the previously reported studies used electron microscopic (EM) evaluation for the diagnosis. This study was conducted to analyze the prevalence of biopsy-proven kidney diseases in a referral center in Iran.

The reports of kidney biopsy samples from 2006 to 2018 referred to a pathology center, affiliated with Tehran University of Medical Sciences were reviewed. The prevalence of different disorders was assessed based on the clinical presentation in 3 age categories, including childhood, adulthood, and elderly.

Among 3455 samples, 2975 were analyzed after excluding transplant-related specimens, suboptimal specimens, and those with uncertain diagnoses. Nephrotic syndrome (NS) (39%) was the most common cause of biopsy followed by subnephrotic proteinuria (18%), hematuria in association with proteinuria (15%), renal failure (9%), isolated hematuria (6%), lupus (4%) and the other non-specific manifestations such as hypertetion or malaise (each one less than 2%). The most common diagnoses included membranous nephropathy (MGN) (17.9%), focal segmental glomerulosclerosis (FSGS) (15.9%), lupus nephritis (LN) (13.7%), minimal histopathological findings (unsampled FSGS versus Minimal Change Disease, 12.1%), Immunoglobulin-A (IgA) nephropathy (6.5%) and Alport syndrome (6.1%). MGN was the most frequent disease before 2013, but FSGS became more frequent after that.

NS and proteinuria were the most indications for kidney biopsy. Although MGN was the most common disease, the prevalence of FSGS has been increasing in recent years and making it the most common disease after 2013. LN and IgA nephropathy are the most common causes of secondary and primary GN presenting with proteinuria and hematuria, respectively.

The prevalence of type 1 and type 2 diabetes is rising worldwide. Diabetes is a major health issue across the globe and a cause of microvascular and macrovascular complications, including nephropathy, neuropathy, retinopathy, blindness, and cardiovascular disease. Long-term control of blood glucose is an important and determining factor in the prevention of these complications.

In this review study, the databases such as Scientific Information Database, PubMed, SID, ISI, and Scopus were searched for articles published from 1975 to 2019, with emphasis on the articles published within the past 10 years. The used keywords were diabetes, insulin, oxidative stress, microvascular, and macrovascular as well as the diseases and disorders related to diabetes.

Considering diabetes, types of diabetes, and its relationship with the organs, it is possible to estimate some degree of prevention, recovery, and timely treatment of diabetes and its effects on other organs

Diabetes mellitus (DM) causes numerous diseases and affects the organs due to hyperglycemia, reduced insulin level or insulin tolerance, increased free radicals, and dysfunction of organs. Delay in the diagnosis of diabetes leads to increased diabetes complications that can be prevented by severe glycemic control.

Despite great advances in hemodialysis, complications during dialysis remain in force. Accurate assessment of dry weight is a determining factor in the prevention of hemodialysis complications. This study is designed to evaluate the effect of adjustment of ultrafiltration rate, on hemodialysis complications, based on dry weight calculation, by measuring the pre-dialysis serum sodium.

  In this single-blind clinical trial 50 patients were included. The patients were randomly divided into case and control groups. First, in the intervention group, the blood sodium level was measured before dialysis. Then, the dry weight of the patients was determined, ultrafiltration was adjusted according to the dry weight, and the patients’ dialysis program was performed. In the control group, dry weight was determined routinely. Blood pressure, muscle cramps, nausea, and vomiting were recorded in both groups for 3 months.

The results showed a significant difference between the two groups in the rate of postoperative nausea and vomiting (P < .05) and muscle cramps during dialysis (P < .05). There were no significant differences between the two groups in blood pressure drop during dialysis and fatigue after hemodialysis in the first, second, and third months (P > .05).

  Accurate assessment of dry weight by the pre-dialysis blood sodium formula, reduces muscle cramps, nausea, and, vomiting.

 Chronic kidney disease is irreversible and may result in end-stage renal failure (ESRF). The kidney replacement program is determined by calculating Kt/V ratios, one of the dialysis efficiency indicators in treatment planning in routine dialysis applications in ESRF patients. We aimed to investigate whether there is a correlation between flow rate and Kt/V ratio.

 All patients were evaluated by B-mode ultrasonography (US) and color doppler ultrasonography (CDUS). The anastomosis line diameter was measured in the B-mode US. The fistula flow rate was calculated in a spectral examination at the anatomical location where the fistulized flow was best obtained at the anastomosis level. Patients with a fistula flow rate above 300 mL/min in CDUS examinations were considered reasonable flow rates. The fistula flow rate in these patients was compared with the Kt/V ratios. Spearman’s rank correlation coefficient was calculated since the normal distribution condition was not met to determine the relationship between variables.

 The results of this study showed a high level (r=0.72, P=0.001) of positive and statistically significant correlation between flow rate and Kt/V ratio in upper arm arteriovenous fistula in patients with end stage renal failure.

 We found a highly positive and statistically significant correlation between fistula flow rate and Kt/V ratio. Low Kt/V ratios have different causes. Low fistula flow should be considered first in low Kt/V values.

Polycystic ovary syndrome (PCOS) is the most common reproductive dysfunction in premenopausal women. PCOS is associated with oxidative stress (OS), which is the main risk factor for renal diseases. This study aimed to investigate the mechanisms responsible for renal injury in a hyperandrogenemic female rat model.  This study was conducted from December 2019 to September 2021 at Shiraz Nephro-Urology Research Centre, Shiraz University of Medical Sciences (Shiraz, Iran). Thirty female Sprague-Dawley rats were randomly divided into three groups (n=10), namely control, sham, and dehydroepiandrosterone (DHEA). Plasma total testosterone, plasma creatinine (Cr), and blood urea nitrogen (BUN) levels were measured. In addition, total oxidant status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI), and histopathological changes in the ovaries and kidneys were determined. Data were analyzed using the GraphPad Prism software, and P<0.05 was considered statistically significant. Plasma total testosterone levels increased by nine-fold in DHEA-treated rats compared to controls (P=0.0001). Administration of DHEA increased Cr and BUN levels and caused severe renal tubular cell injury. In addition, plasma and tissue (kidney and ovary) TAC levels decreased significantly, but TOS levels and OSI values were significantly increased (P=0.019). Significant damage to both glomerular and tubular parts of the kidney and ovarian follicular structure was observed in the DHEA group. Hyperandrogenemia caused systemic abnormalities through OS-related mechanisms and damaged renal and ovarian tissues. DHEA treatment in rat models is recommended to study the mechanisms that mediate PCOS-associated renal injury.

Gentamicin is an aminoglycoside antibiotic used in the treatment of Gram-negative bacterial infections. One of the side effects of this antibiotic is nephrotoxicity. In this study, the protective effect of Melissa officinalis L. extract on diabetes- and gentamicin-induced nephrotoxicity was studied.

Forty male Wistar rats were randomly divided into four groups. The first group received distilled water, and the second group received M. officinalis L. extract (100 mg/kg) for 28 days. The third group received streptozocin (60 mg/kg) for 18 days, and then received gentamicin (80 mg/kg) on day 20 for 8 consecutive days. The fourth group received streptozocin, gentamicin, and M. officinalis L. extract for 28 days. Serum levels of blood urea nitrogen (BUN), creatinine, glucose, and amylases were measured. The right kidney was maintained in 10% formalin for hematoxylin and eosin staining, and oxidative stress markers in the left kidney were assessed.

In the third group, serum BUN, creatinine, glucose, amylase, and malondialdehyde (MDA) increased, while glutathione peroxidase, superoxide dismutase, and catalase activities decreased significantly compared to the other groups (P<0.05). The extract of M. officinalis L. significantly inhibited the enhancement of serum creatinine, BUN, glucose, amylase, and MDA (P<0.05). Histological examinations showed that diabetes and gentamicin could lead to kidney damage by inducing necrosis and inflammation. Finally, the extract of M. officinalis L. could significantly reduce the adverse effects of both gentamicin and diabetes (P<0.05).

The extract of M. officinalis L. improves biochemical parameters and histological lesions in diabetic rats treated with gentamicin.

 The COVID-19 pandemic is a phenomenon that has infected and killed many people worldwide. Underlying diseases such as diabetes mellitus, heart failure, and chronic kidney disease (CKD) can affect the severity of COVID-19 and aggravate patients' condition. This study aimed to predict the severity of the COVID-19 disease in CKD patients by combining feature selection and classification methods.

 This study was conducted between March 2021 and September 2021 in Isfahan University of Medical Sciences. The data set includes 83 traits of 72 kidney transplant patients, 231 kidney failure patients, and 105 dialysis patients. The data set has 77 input attributes, including age, sex, diabetes mellitus, hypertension, ischemic heart disease, chronic lung disease, and kidney transplant.
In the proposed method, the combination of ant colony algorithm and the CHAID method has been used.

 The combination of the ant colony algorithm and CHAID method leads to better performance than CHAID alone. A total of 22 rules were extracted, of which 6 rules with a confidence of more than 60% were introduced as selected rules. The most reliable rule states that if a person has CKD stage 5, is not undergoing dialysis (5ND), and is short of breath, in 81% of cases the type of COVID-19 disease will be severe.

 In this study the severity of COVID-19 disease in kidney patients was measured using variables including age, diabetes mellitus, blood pressure, CKD stage, etc. The results showed that high levels of kidney disease can lead to severe COVID-19.

Bleeding events are the most common complications after kidney biopsy. This study aims to evaluate the effect of desmopressin administration on bleeding complication, in native kidney biopsy candidates with reduced kidney function.

This double-blind randomized clinical trial enrolled 18 to 80 years old patients with 15 < eGFR < 90 mL/min/ 1.73m² from July 2017 to August 2020. Patients were randomly assigned to receive either 3 μg/kg of intranasal desmopressin acetate or 1 mL/kg of intranasal sodium chloride 0.65%, one hour before ultrasound-guided, percutaneous native kidney biopsy. The primary outcome was the post-biopsy bleeding complications, and secondary outcomes were the volume of perirenal hematoma, and changes of post-biopsy hemoglobin and hematocrit level, plasma sodium and blood pressure (Clinical Trial Registration ID:IRCT20090701002112N3).

A total of 120 patients (58 men and 62 women), 60 patients in each group, were analyzed. The mean age and eGFR of the patients were 45.29 ± 15.95 years and 51.77 ± 18.02 ml/min/ 1.73m², respectively. Desmopressin administration significantly decreased post-biopsy perirenal hematoma compared to placebo (7/60 [11.6%]) vs. 33/60 [40%]; P < .05), and the hematoma volume was significantly smaller in the desmopressin group, in case of hematoma formation (2.31 ± 1.17 vs. 7.72 ± 5.45 mm³, P < .05).

Desmopressin administration before kidney biopsy is a safe and effective strategy to prevent bleeding complications. Considering absolute risk reduction of about 28%, the number needed to treat is about 4 procedures. We recommend considering desmopressin administration before percutaneous native kidney biopsy.

Type II mixed cryoglobulinemia is a systemic disease mediated by immune complexes. Renal involvement is present in almost one third of the cases and the membranoprolifer-ative pattern is the most common histological presentation. In turn, in Waldenström macroglobulinemia, renal impairment is rare, with few cases of associated cryoglobu-linemia being reported. The authors present the case of a patient with type II mixed cry-oglobulinemia associated with Waldenström macroglobulinemia diagnosis.

Nearly 850 million people suffer from chronic kidney disease (CKD) worldwide, indicating its importance as a public health problem. Several studies have confirmed that quality of life is strongly associated with increased risks of morbidity and mortality in CKD patients, and hemodialysis patients have a lower level of health-related quality of life (HRQoL) compared to the general population.

This study tries to investigate HRQoL and kidney disease quality of life (KDQoL) and explore their associated factors among hemodialysis patients in the Souss Massa region in Morocco.

Four hundred and forty-one hemodialysis patients were included in this cross-sectional study. The participants were at or above 18 years old, received at or above three months of hemodialysis, did not have serious changes in their lifestyle, and signed the consent form. Clients who were unable to respond or did not sign the consent form were excluded. Sociodemographic, clinical, and biological parameters were collected, and quality of life (QoL) (using KDQOL-SF-v1.3) was assessed. Through univariate and multivariate analysis, factors associated with HRQoL and kidney function could be determined.

The prevalence of poor QoL among hemodialysis patients in HRQoL and KDQoL was 29.5% and 21.3%, respectively. In the multivariate analysis, the poor HRQoL was significantly associated with anemia (CI: 1.02 - 2.79; P = 0.037), frequency of dialysis sessions per week (CI:1.04 - 4.66; P = 0.030), and poor KDQoL was associated with age (CI: 0.24 - 0.79; P = 0.006), occupational status (CI: 1.48 - 8.53; P = 0.028), and support for medical costs (CI: 0.13 - 0.73; P = 0.007).

According to the results, hemodialysis patients have poor QoL. Factors with a significant association were age, anemia, occupational status, number of dialysis sessions, and medical coverage. Future directions for these patients should try to treat anemic patients, intensify dialysis sessions, and reduce or guarantee free medical costs.

  Bartter syndrome (BS) is a salt losing tubulopathy due to impairment of the transport mechanisms at the thick ascending limb of the Henle’s loop. The aim of this study was to report the clinical course of patients with BS.

  Patients with BS were followed from 1996 to 2020 and enrolled to a systematic protocol to confirm primary BS by evaluating the metabolic derangements, nephrolithiasis and nephrocalcinosis. Treatment was based on standard guidelines. Comparisons were made between data at baseline and at the last visit.

  A total of 13 patients (7 males) with primary BS were analyzed. Two patients had a mutation of the KCNJ1 gene. Age at diagnosis was 3 ± 4.5 years and the follow-up period was 11.19 ± 6.76 years. Metabolic alkalosis was initially detected in 76.92% and remained stable at the last visit (P > .05). Hypokalemia was present in 61.5% of patients at diagnosis, but sustained in 38.46% at the last visit (P < .05). Urine calcium level was 13.3 ± 9.6 mg/ kg/d at the first visit, and significantly reduced to 3.7 ± 2.0 mg/ kg/d at the last visit (P < .05). Nephrocalcinosis was detected by first kidney ultrasonography in 53.8% of patients. Kidney function was preserved, with a glomerular filtration rate of 120.1 ± 28.7 mL/min/ 1.73m2 at last visit. Growth was completely recovered in 71.42% and partially improved in 14.28% of patients after treatment, respectively. All patients received indomethacin and potassium chloride salts.

Long-term follow-up of this cohort of BS showed favorable outcomes after treatment resulting in metabolic normalization and growth catch-up in most patients.

Trace element deficiency is common among patients with end‑stage renal disease (ESRD); the reason is that since these patients undergo dialysis, they lose these elements more than healthy people, and also the use of trace elements is restricted due to loss of appetite. Selenium (Se) is a trace element that is essential for the oxidative stress defense system. Se deficiency leads to some complications similar to those often seen in ESRD patients, such as all-cause mortality due to cardiovascular diseases, bone loss, uric acid elevation, and anemia. This article aims to review the evidence on consequences of Se deficiency in ESRD patients, as well as effects of Se supplementation in hemodialysis patients. Multiple databases were searched to summarize the available evidence on selenium’s role in kidney diseases. Since the complications of ESRD and those of Se deficiency are mostly similar, this triggers the idea that Se deficiency may be considered as a cause of these problems, but it needs to be more assessed that Se deficiency is a single factor or there are other factors participated in. Also the role of Se supplementation on resolving the mentioned complications, needs to be more studied through welldesigned clinical studies.