فهرست مطالب

Nephro-Urology Monthly - Volume:9 Issue:3, 2017
  • Volume:9 Issue:3, 2017
  • تاریخ انتشار: 1396/03/31
  • تعداد عناوین: 11
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  • Mario Bonomini *, Assunta Pandolfi, Vittorio Sirolli, Arduino Arduini, Lorenzo Di Liberato, Natalia Di Pietro Page 1
    Patients suffering from chronic renal failure have a higher burden of cardiovascular events, which increases in a dose-dependent fashion as renal function worsens. Increased cardiovascular risk in these patients is thought to be mediated by the simultaneous presence of both traditional and non-traditional cardiovascular risk factors, the latter being associated with renal impairment. Red blood cells are usually considered as carries of nutrients for tissues and respiratory gases, less so as compartments essential to vascular integrity. However, erythrocyte number, size, and integrity seem to severely affect cardiovascular morbidity and mortality as established in recent clinical studies with large patient cohorts. In particular, the role of red blood cells in chronic renal failure tends only to be considered exclusively in relation to a change in their number. However, these cells in the uremic milieu are prone to many alterations, which may adversely affect the cardiovascular system. In this review, we highlight the main qualitative erythrocyte alterations that may have a pathophysiologic role in the elevated cardiovascular risk of chronic renal failure.
    Keywords: Red Blood Cell, Renal Insufficiency, Phosphatidylserine, Nitric Oxide, Cardiovascular Disease, Endothelium, Uremia, Hemodialysis
  • Fate of Abstracts Presented at the First International Congress of Nephrology and Urology, Tehran, Iran, 2015
    Seyed-Mostafa Hosseini-Zijoud, Farnaz Barzi, Aidin Lotfiazar, Behzad Einollahi * Page 2
    Objectives
    The publication rate of abstracts presented at a scientific congress is considered as an indicator of congress’s scientific quality. This rate is in range of 11% to 78% with an average of 45% in international medical congresses. The current survey aimed to determine the publication rate of the presented abstracts at the first international congress of nephrology and urology (ICNU) in 2015.
    Methods
    Data of oral and poster presentations including abstracts’ titles and authors were gathered from the proceeding of the first ICNU, Tehran, Iran, 2015. The presented abstracts were searched in Scopus, PubMed, and ISC (for Persian language published papers). All the abstracts were categorized based on presentation type (oral or poster presentation), topic, study type and design, publication status, time interval between the presentation and the publication date, and the journal publishing the full text of the abstracts. Statistical analysis was done by SPSS (version 18, SPSS Inc., Chicago, IL, USA).
    Results
    The total number of abstracts accepted at the first ICNU was 210 (63 as oral and 147 as poster). The results showed that 49 out of 210 abstracts were published as full-text articles in indexed journals, giving the overall publication rate of 23.3%. 6 out of 49 published papers were in Persian Language. In this survey, the rate of publication was 41.3% for oral presentations. The abstracts of prospective studies and original articles were more likely to be published in journals. The median time to publication was 5.3 months (range 1 - 12 months).
    Conclusions
    Novel ideas and innovative approaches were discussed at the first ICNU, Tehran, Iran, 2015. The 23.3% publication rate found in the current study was lower than the mean publication rate of previous medical congresses. If the presented abstracts in a congress are not published as papers to be available to all, it would be waste of effort and time.
    Keywords: Publication Rate, Abstract, International Congress of Nephrology, Urology (ICNU), Oral Presentation
  • Shiva Samavat, Mohsen Nafar *, Alireza Khoshdel, Behrang Alipour- Abedi Page 3
    Background
    Anemia resistant to erythropoietin stimulating agents (ESAs) is a risk factor for all-cause mortality. Determining the etiologies of hyporesponsiveness may help overcome the resistance. We investigated the contributing factors in a population of hemodialysis patients.
    Methods
    In a multicenter cross-sectional study, from January 2015 to May 2015, point-prevalent hemodialysis patients from 22 dialysis centers in Tehran, Iran, were enrolled. Demographic, clinical, and laboratory data and drug history were recorded. ESA hyporesponsiveness index (EHRI) was calculated by dividing weekly ESA dose per kilogram of body weight (IU/Kg/W) by hemoglobin level (g/dL). Patients with EHRI ≥ 16.49 (4th quartile) were compared with those with EHRI
    Results
    A total of 1224 patients were enrolled among whom, 306 (25%) had an EHRI ≥ 16.49 with a mean hemoglobin level of 9.8 ± 1.4 g/dL. There was no age, gender, or dialysis vintage difference within the groups. Iron status, parathormone, CRP, and diabetes were also similar. Hyporesponsive patients had lower body mass index (BMI) and lower serum albumin (P
    Conclusions
    Apart from the most validated parameters responsible for ESA hyporesponsiveness (e.g. Iron deficiency, dialysis inadequacy, and poorly controlled serum phosphate level), other potential risk factors such as treatment with ACEi/ARB should be evaluated. Discontinuation of these drugs might be a therapeutic strategy to overcome ESA resistance.
    Keywords: Hemodialysis, Anemia, ESA, Hyporesponsiveness, Erythropoietin Hyporesponsiveness Index (EHRI)
  • Shiva Samavat, Somayeh Fatemizadeh*, Hedieh Fasihi, Marieh Farrokhy Page 4
    Background
    Restless leg syndrome (RLS) is a sensorimotor neurological disorder with high prevalence among patients with end-stage renal disease (ESRD) and is associated with sleep and mood disturbances. The current study evaluated the associations between RLS, depression and insomnia in patients undergoing hemodialysis.
    Methods
    The current cross sectional study collected sociodemographic, laboratory data, and medical history of 235 patients undergoing hemodialysis. RLS was assessed by a questionnaire designed by national institutes of health/international RLS study group (IRLSSG), depression by hospital anxiety depression scale (HADS), and insomnia by Pittsburgh sleep quality index (PSQI).
    Results
    The prevalence of RLS in patients undergoing hemodialysis was 23.4%; out of which 43.6% had severe and very severe RLS. Patients with RLS had a positive family history of RLS (P value
    Conclusions
    RLS is prevalent among patients undergoing dialysis and could lead to depression, even in the absence of insomnia. Thus, it seems that appropriate diagnosis and management of RLS would make a difference in quality of life of patients undergoing hemodialysis.
    Keywords: Restless Leg Syndrome, Insomnia, Depression, Hemodialysis
  • Atieh Makhlough, Mohammadreza Mahdavi, Iradj Maleki, Lotfollah Davoodi, Tahoora Mousavi, Seyed-Hosein Hasani-Mansoor, Marjan Makhlough, Mohammadreza Haghshenas* Page 5
    Background
    Hemodialysis is one of the renal replacement therapies in patients with end-stage renal failure. The current study aimed at identifying the prevalence of hepatitis C virus (HCV) infection in hemodialysis population, and comparing serological (enzyme-linked immunosorbent assay) and molecular (polymerase chain reaction) methods to detect HCV infection in North of Iran.
    Methods
    Serum samples from 162 patients undergoing chronic hemodialysis were collected in 2 hemodialysis units of Sari city (North of Iran). HCV RNAs were isolated from samples using RIBO-prep nucleic acid extraction kit (AmpliSens®, Russia). Total RNAs were extracted from samples and real-time polymerase chain reaction (PCR) was performed using HCV-FRT PCR kit (AmpliSense, Russia) according to the manufacturer’s instructions.
    Results
    In the study, 7 (4.3%) cases were HCV-Ab positive and 155 (95.7%) HCV-Ab negative. Additionally, 11 patients (6.8%) were HCV-PCR positive, while 151 (93.2%) were HCV-PCR negative. Among 11 HCV-PCR positive patients, 7 (63.6%) were HCV-Ab positive and 4 (36.4%) were HCV-ab negative. HCV-ab test was not positive in any of the HCV-PCR negative patients.
    Conclusions
    The results showed that the specificity of HCV-RNA detection was significantly higher than that of the conventional HCV-ab test. The gold standard test to confirm HCV positive should be PCR method.
    Keywords: Hemodialysis, HCV, ab Test, HCV, PCR Test
  • Treatment Failure of Botulinum Toxin A in Patients with Idiopathic Overactive Bladder: Why Do Patients Discontinue Treatment?
    Tom Marcelissen, Mohammad Sajjad Rahnamai *, Beverley Brierley, Brigitte Schurch, Peter De Vries Page 6
    Objectives
    The study aimed to evaluate the long-term compliance and reasons for discontinuation of intravesical botulinum toxin A (BoNT-A) treatment in women with idiopathic overactive bladder syndrome (iOAB).
    Methods
    All patients who had been treated with BoNT-A between 2004 and 2010 were invited to join a written survey in June, 2015. Only women with idiopathic OAB symptoms were included. The survey was designed first to assess current urinary symptoms in patients who failed BoNT-A treatment, and second to evaluate their experiences with BoNT-A and subsequent treatments.
    Results
    In total, 74 patients who discontinued BTX-A treatment were identified. The response rate was 62%. The most common reasons for discontinuation of treatment were insufficient effect (37%), the need for clean intermittent self-catheterization (CISC, 13%), and urinary tract infections (UTI, 9%). 17% of the patients reported that they did not want a new treatment despite good effects. After an average follow-up of 92 months, more than three quarters (76%) of the patients suffered from urgency incontinence. In most patients, incontinence had a great influence on daily life (average score of 7 on a scale of 10). During the time of this survey, 25% of the patients used drugs for their OAB symptoms, 15% were referred for sacral neuromodulation, and 1 patient underwent urinary deviation.
    Conclusions
    Our study provides important information on the follow-up and the reasons for discontinuation in patients with idiopathic OAB. This information can be used in counselling of patients and further improvement of BoNT-A treatment.
    Keywords: Overactive Bladder, Botulinum Toxin, Incontinence, Urgency, Idiopathic
  • Nouraddin Mousavinasab, Mojgan Jalalzadeh* Page 7
    Background
    Serum cystatin C has been identified as a marker for the estimation of glomerular filtration rate (GFR). Although this marker is more sensitive than creatinine, it is too expensive and not available in all laboratories. In this study, we compared cystatin C-based equations with creatinine-based formulas to select the most precise creatinine-based formula for estimating GFR in patients with chronic kidney disease (CKD).
    Methods
    120 patients with CKD were enrolled in this cross-sectional study. The patients were divided into groups according to BMI (
    Results
    The mean age of patients was 56.4 ± 16.4 years. The mean of GFRs using C-G, MDRD, and abbreviated MDRD formulas were 36.2 ± 14.3, 32.6 ± 11.4, and 32.4 ± 11.3 mL/min/1.73 m2, respectively. The mean of GFRs using Filler, Le Bricon, Larsson, Rule, and Hoek equations were 54.7 ± 20.1, 53.0 ± 15.7, 43.6 ± 18.5, 45.1 ± 17.2, and 46.2 ± 16.2 mL/min/1.73 m2, respectively. The closest correlation was observed between GFRs generated by Abbreviated MDRD and cystatin C-based equations (P
    Conclusions
    GFRs estimated by Abbreviated MDRD equation are closer to GFRs estimated by cystatin C equations regardless of patients’ BMI in CKD subjects.
    Keywords: Glomerular Filtration Rate (GFR), Creatinine, Cystatin C, Chronic Kidney Disease (CKD), Body Mass Index (BMI)
  • Samad Zare* Page 8
    Background
    Although percutaneous nephrolithotomy is most commonly performed with fluoroscopic access, yet, phobia and risks of radiation exposure are 2 important dilemmas. Herein the feasibility of flank position ultrasound guided percutaneous nephrolithotomy for management of renal stones was assessed.
    Methods
    Between September 2012 and June 2016, 250 cases (134 males and 116 females) with renal stone underwent ultrasonography-guided percutaneous nephrolithotomy under lateral decubitus position. The exclusion criteria were active urinary tract infection and bleeding status. The peri-operative surgical outcomes were recorded and analyzed.
    Results
    The mean age of patients was 42.0 ± 13.4 years. Twelve patients were children under 12 years old. Mean size of the stones was 4.2 ± 1.1 cm (range from 2.5 to 5.3 cm). Mean access and operative times were 15.5 ± 2.3 and 68 ± 14.5 minutes, respectively. In 45% of patients, superior calyx was selected for access. History of previous open stone surgery was obtained in 24 cases. Early complete stone free rate (SFR) was 68%, and after auxiliary procedures (SWL and TUL), this increased to 88%. The mean hemoglobin reduction was 1.9 ± 0.9 gr/dL. Blood transfusion was needed in 6 cases (2.4%). Prolonged or delay hemorrhage did not occur in any of the patients. One patient was complicated by moderate degree of pneumothorax and managed with chest tube insertion. Solid or viscus abdominal organ injury had not happened.
    Conclusions
    This study suggested that the feasibility and outcomes of ultrasonography-guided percutaneous nephrolithotomy are comparable with the standard fluoroscopic approach. Also flank position can facile this procedure.
    Keywords: Ultrasound, Percutaneous Nephrolithotomy (PCNL), Renal Stone, Flank Position
  • Maryam Sarbishegi, Enam Alhagh Charkhat Gorgich*, Ozra Khajavi Page 9
    Background
    Olive (Olea europaea), from the Oleaseae family, is a very popular plant for its biological and pharmacological characteristics. Olive tree derivatives possess antioxidant, anti-inflammatory, antihyperlipidemic, and cardioprotective effects.
    Objectives
    The current study aimed at evaluating the effect of olive leaves extract (OLE) on sperm quality and antioxidant capacity in testis of rats exposed to rotenone (ROT).
    Methods
    In the current experimental study, 36 male Wistar rats were divided into 6 groups (n = 6). Control, Sham, ROT, and 3 ROTs treated with OLE (75, 150, and 300 mg/kg/day). ROT 3 mg/kg/48 hours was injected subcutaneously (s.c), and vehicle or OLE was administrated by oral gavage for 30 days. At the end of the study, animals were scarified and their testis tissue and epididymis samples were removed and their sperm parameters (viability, motility, and sperm count), total antioxidant capacity (TAC), and malondialdehyde (MDA) level were measured.
    Results
    The results showed a significant decrease in sperm parameters and TAC in the ROT group. MDA level increased in ROT group compared to that of the control group. The 30 day administration of OLE significantly improved the sperm qualitative parameters and TAC, and decreased the elevation of MDA in the treated groups (P value
    Conclusions
    In conclusion, the antioxidant effects of OLE significantly increased sperm quality and TAC, and decreased MDA level in the testis of rats exposed to ROT. These results revealed that OLE improved the sperm quality and suggested that OLE may treat infertility.
    Keywords: Rotenone, Olive Leaves Extract, Sperm Quality, Antioxidant Status
  • Hamed Akhavizadegan* Page 10
    Introduction
    In this study, we presented two cases with lower urinary tract symptoms and missed urinary stone that were diagnosed by the computed tomography (CT) scan.
    Case Presentation
    We reported two elderly men with severe irritative bladder symptoms who failed to be diagnosed with routine work-ups, including urine analysis and culture, urine cytology, ultrasonography, cystoscopy and urodynamic studies. Abdomino-pelvic nonenhanced spiral CT scan was performed. Missing stones were detected by the helical CT scan without contrast, which were treated by intracorporal lithotripsy. The symptoms were relieved following stone removal.
    Conclusions
    According to these two cases, there may be a diagnostic role for CT scan in evaluation of the irritative bladder symptoms.
    Keywords: Voiding Dysfunction, Irritative Bladder Symptoms, CT Scan, Stone, LUTS
  • Reza Mahdavi Zafarghandi, Mahmood Reza Kalantari, Alireza Akhavan Rezayat *, Amir Abbas Asadpour Page 11
    Prostate cancer (PC) is one of the most common forms of malignancies and the second cause of cancer death all around the world and the eight causes in Iran. The main portion of PC is adenocarcinoma, in some cases neuroendocrine differentiation occurs. Neuroendocrine prostate cancers (NePCs) incidence varies from 0.5% to 2% of all prostate cancers. Large cell neuroendocrine differentiation is very rare. In this study we presented a 71-year-old man with large cell neuroendocrine carcinoma of the prostate.
    Keywords: Neuroendocrine, Prostate Cancer, Adenocarcinoma