Nephro-Urology Monthly
Volume:9 Issue: 5, Sep 2017

The main indicator of long-term glycemic control in type 1 diabetes and its complications is glycosylated hemoglobin (HbA1c). Considering that there are little studies on the correlation of YKL-40 with HbA1C in type 1 diabetes, we evaluated such correlation to suggest YKL-40 as both diagnostic and prognostic marker of type 1 diabetes poor control and nephropathy.
49 patients of type 1 diabetes not suffering from any diabetic complications during recent 5 years and 43 sex- and age-matched healthy controls participated in the study. Taking fasting blood and urine samples, we measured CBC, serum levels of YKL-40, HbA1c, creatinine, lipids, and urinary concentration of albumin and creatinine using standard laboratory methods.
Serum level of YKL-40 was significantly higher in type 1 diabetes compared to controls (P Although there was a significant increase in serum level of YKL-40 in type 1 diabetic patients, it did not show any correlation with both metabolic and nephropathic states of diabetes.

Assisted reproductive technique is the last treatment resort for idiopathic male infertility (IMI). In recent years, antioxidants have received vast attention to treat IMI by decreasing seminal oxidative stress.
In this cross-sectional before-after study, we evaluated the effects of grape seed extract (GSE) as an antioxidant on seminal chemistry. Twenty-nine patients with IMI were treated with GSE 600 mg per day for 3 months. Seminal catalase, superoxide dismutase and malondialdehyde, and serum FSH, LH, and testosterone levels were evaluated both at the beginning and at the end of the study.
Mean age of the patients was 32.5 ± 4.9 years. GSE consumption resulted in increased semen catalase (44.67 ± 17.11 vs. 53.05 ± 18.6, P = 0.016), decreased semen malondialdehyde (1.77 ± 0.48 vs. 1.55 ± 0.43, P = 0.024), and increased serum FSH (3.53 ± 1.51 vs. 4.3 ± 2.00, P = 0.026).
Our study revealed GSE effectiveness in decreasing seminal oxidative stress in patients suffering from IMI.

Short-term pulsatile perfusion during cardio pulmonary bypass has shown higher protection for renal physiology, following standard preservation of glomerular filtration and reduction of renal tissue damage.
In this randomized clinical trial study, 70 patients, who had undergone CABG surgery were divided to 2 groups; pulsatile and non-pulsatile groups. The researchers transferred continuous blood flow to pulsatile blood flow during proximal graft using cardiac contraction. Patients’ laboratory tests, such as blood urea nitrogen (BUN) and creatinine were checked preoperatively, at the arrival of the open heart intensive care unit (ICU-OH), and 24 and 48 hours after admission.
Both case and control groups had significantly increased BUN and creatinine. Increased creatinine on the first and second postoperative day was significantly higher in the control group. Furthermore, BUN increased on the second day in the control group and was significantly higher than the case group
Despite the rise in BUN and creatinine in the 2 groups, there were no cases of renal failure in the patients. However, the results of this study regarding creatinine and BUN criteria were supported by the pulsatile perfusion method during the proximal graft by using a cardiac contraction in CABG surgery.

Dulaglutide and liraglutide are glucagon-like peptide-1 receptor agonists. We investigated the effects of once-weekly dulaglutide on glycemic control and renal function compared to once-daily liraglutide in patients with advanced-stage diabetic nephropathy.
Changes over a 12-month period in levels of glycated hemoglobin, urine protein/creatinine ratio, and annual change in estimated glomerular filtration rate were retrospectively analyzed in 10 patients with advanced-stage diabetic nephropathy after changing from once-daily liraglutide (0.9 mg/day) to once-weekly dulaglutide (0.75 mg/week) (dulaglutide group). The control group comprised 10 patients with advanced-stage diabetic nephropathy who had continued once-daily liraglutide (0.9 mg/day) (liraglutide group).
The glycated hemoglobin level significantly decreased in the dulaglutide group after switching from liraglutide to dulaglutide (-0.81 ± 1.03% at 12 months from baseline, P Once-weekly dulaglutide may be more advantageous for glycemic control compared to once-daily liraglutide in patients with advanced-stage diabetic nephropathy.

Ureterovesical junction obstruction (UVJO) is the result of an anatomic or a functional abnormality in the distal segment of the ureter. There are many types of UVJO, different in their cause, presentation, imaging characters, and prognosis.
The aim of this study was to discuss the postoperative natural course and prognosis of patients undergoing standard approaches on the management of primary UVJO by one surgeon in a 10-year period starting from 2004.
From January 2004 to October 2013, 64 patients who underwent ureteral tapering and stenting ureteroneocystostomy for complicated primary UVJO participated in the study.
The mean age of patients was 26 years (range: 11 months to 73 years). The mean hospital stay was 5 days (range: 4 to 7 days). The post-operative time was between 1 and 2 hours. Double J stent was left in place for 4 weeks. Post-operative follow-up was at least one year. No major complication was encountered, instead, a decrease in symptoms in all patients and an increase in renal function in 40 out of 64 (62.5%) patients were observed in the one-year follow-up of the diethylenetriaminepentaacetic acid (DTPA) renal scanning. Only 3 patients had fever as a postoperative minor complication.
Decision making in the treatment of UVJO is somewhat a dilemma. This condition is occasionally asymptomatic and uneventful, and may be detected accidentally during an unrelated work-up; nonetheless, it may also cause serious life threatening complications. Surgical management in complicated cases may be a safe and viable treatment option both in children and in adults.

Infertility affects 15% of couples and varicocele is the most common cause of male infertility. Oxidative stress is recommended as a possible mechanism of infertility. Crocus sativus (saffron) has been recognized as having antioxidative properties and is presumed to improve sperm parameters.
The present study aims to evaluate the effect of saffron on semen analysis of infertile men with clinical varicocele after varicocelectomy.
In this randomized clinical trial, 48 infertile men candidates for varicocelectomy were randomly assigned to receive 60 mg edible saffron capsules once every other day (n = 27) or a similar regimen of placebo (n = 21) for 6 months. The two groups were compared for changes in semen parameters.
There was no significant difference between groups in semen parameters before treatment as well as in semen volume, morphology, and sperm count post-treatment, but motility was significantly higher in the saffron group (30.00 ± 14.46 vs. 21.71 ± 11.45; P = 0.03). There was one (3.7%) complication in the saffron group.
Our results showed that except improving sperm motility, saffron has no effect on other semen parameters in infertile men with clinical varicocele after varicocelectomy.

This study aimed at estimating the prevalence of bacterial strains isolated from patients with community acquired urinary tract infections (UTIs) and comparing the antibiotic susceptibility patterns among different genders.
This prospective study was conducted between June 2011 and August 2012 in Iran, Tehran, on patients referred with symptomatic UTI. Midstream samples were taken and sent to the laboratory. The bacterial resistance was determined in patients with proven UTI by the Kirby Bauer’s disc diffusion method. Data were stratified by age and gender.
A total of 762 individuals were included in this prospective study, from which 573 (75.1%) were female and 189 (24.9%) were male patients. The most prevalent pathogen in different age, gender, inpatient and outpatient groups was Escherichia coli. The E. coli isolates were significantly higher in females compared to males (P = 0.03). High prevalence of resistance was observed against nalidixic acid (77.9%) in male patients, while amoxicillin (74%) was the most resistant antibiotic in females. However, the highest sensitivity was observed against imipenem in both male and female groups (97.9% and 97.2%, respectively) with no significant difference among them (P > 0.05).
To date, this is the first study to determine the distribution and antibiotic susceptibility patterns in patients with UTI in Iran. This study showed that E. coli was the leading bacterial pathogen of community acquired UTIs in Iran, Tehran. An increasing resistance to first line antibiotics for UTI pathogens was also indicated, which emphases the need to improve empiric treatment.

Despite the well-known increased risk to develop non-melanoma skin cancer (NMSC) due to the long-term immunosuppression, data about melanoma incidence and prognosis in solid organ transplanted patients are still debated. Literature studies report a relative risk for melanoma varying from 1.2 and 5.8 in different solid organ recipients, probably as a consequence of the difference in immunosuppressive treatments and endogenous and exogenous risk factors. Here we report data about melanoma incidence, prognosis and clinicopathological characteristics in a series of 686 kidney transplant recipients. In this series, melanoma incidence was 3.5%; most cases were represented by in situ or thin melanomas mainly related to sun exposure, and the prognosis of our patients was good except for only one case with a progressive disease. Our experience confirms the importance of a regular dermatological follow-up and of education to correct sun exposure even in transplanted patients.

There are some legislated criteria for improving the quality of articles’ abstract presentation.
The aim of this study was to evaluate oral and poster abstracts submitted at the first International Congress of Nephrology and Urology, held in Tehran during June, 2015.
One hundred and forty-eight abstracts were assessed by 2 reviewers. Using the 19-item Timer checklist, the researchers examined the study design, number of au-thors, field of study, and language and quality score for each abstract. The comparisons between groups were done using the Mann-Whitney and Kruskal-Wallis tests by SPSS software with P values of less than 0.05 considered as significant.
The quality score mean of all articles of congress was 0.65±0.14. Structured abstracts (P = 0.026), articles of student field (P value = 0.032), and of human observational design (P value = 0.007) had a significantly better quality score. The best average score of the Timer checklist was related to subject's appropriateness for the study question (1.89 ± 0.35) and the worst was related to method and appropriateness of subjective selection (0.89 ± 0.84).
Developing a specific quality scale for basic studies, assessing articles stricter before acceptance and necessitating authors to write their abstracts in structured form are required.

In this report, we present a rare case of HCV-negative cryoglobulinemic glomerulonephritis and recurrent prostate cancer in a 79-year-old Caucasian man. In the literature, only a few cases of solid cancer-associated cryoglobulinemia have been reported, but none have shown both renal involvement and prostate cancer.
A 79-year-old Caucasian man with limb and abdominal purpura, peripheral edema, nausea, and oligoanuric renal failure was admitted to our renal unit in July 2016. In 2007, the patient was successfully treated with radiotherapy for localized prostate cancer and underwent regular follow-up until July 2016 when he developed a recurrence of prostate cancer and was treated with radiotherapy. He was obese and affected by hypertension and stable mild chronic kidney disease (last serum creatinine level, 1.4 mg/dL in July 2016). Serum creatinine level was 5.9 mg/dL upon admission, and blood urea nitrogen was 250 mg/dL with a urinary output of almost 400 ml/day. He tested negative for HCV infection, but positive for type II cryoglobulinemia. Considering the severity of the clinical course of renal biopsy, renal histology was performed, demonstrating cryoglobulinemic membranoproliferative glomerulonephritis. Given the concomitant recurrence of prostate adenocarcinoma, pulse steroid therapy was initiated, followed by prednisone (1 mg/kg/day), without using others immunotherapy agents, such as cyclophosphamide and/or rituximab. Limb and abdominal purpura improved after steroid therapy, whereas renal function failed to recover and hemodialysis treatment was initiated after positioning a central venous catheter. Hemodialysis treatment ameliorated the clinical status of our patient, who is still under chronic treatment.
Type II mixed cryoglobulinemia (MC) is a vasculitis of unknown etiology. HCV infection is the major cause of nearly 90% of MC cases. However, contribution of genetic and/or environmental factors remains controversial, as approximately 10% of MC cases present no evidence of HCV infection. These cases are defined as essential MC and are generally associated with a severe course of and suboptimal responses to conventional therapies. This documented report provides the basis for a comprehensive literature review of the rare occurrence of HCV-negative paraneoplastic cryoglobulinemia.