Nephro-Urology Monthly
Volume:10 Issue: 4, Jul 2018

Context:Atherosclerosis is considered as the important cause of death worldwide and especially among kidney-transplanted patients. It is said that an aggressive intervention is needed for preventing new atherosclerotic events post kidney transplantation. Our main purpose was to determine the effect of cytomegalovirus (CMV) exposure on the atherosclerotic events among kidney-transplanted patients using a systematic review and meta-analysis.
Evidence Acquisition:Electronic databases (PubMed, Scopus, Science Direct, and Web of Science) were systematically searched to find related studies for the effect of CMV exposure on the atherosclerosis in the kidney transplantation setting. Quality assessment was done and then because of existence of heterogeneity we used random-effect model to calculate risk ratio (RR) and 95% confidence interval (CI) for the CMV effect on the atherosclerosis.
Ten Studies were included in our systematic review. Eight of them proposed CMV as a risk factors for atherosclerosis among kidney-transplanted patients. According to available data for analysis, seven papers were included in our meta-analysis and showed RR of 1.46 (95% CI: 1.15 - 1.85) for the mentioned effect and based on the trim and fill method the corrected RR was as 1.26 (95% CI: 1.01 - 1.65).
Our meta-analysis showed that exposure with CMV can lead to atherosclerosis events among kidney-transplanted patients. However, more original studies are still needed to explore the association between the type of CMV exposure and atherosclerotic events.

Recurrent urinary tract infection is common in adult females. This study aimed at identifying lower urinary tract abnormalities in females with recurrent urinary tract infections based on cystoscopy findings and evaluating the diagnostic yield of cystoscopy in these patients.
In this cross-sectional study, females (above 18 years) with recurrent urinary tract infection, who were referred to the urology clinic of Kerman University of Medical Sciences, Iran, in 2014 to 2016, were evaluated. After collecting demographic information, urine culture and urinary tract ultrasonography were performed for all patients; those with gross or microscopic hematuria, abnormality in imaging, neurogenic bladder, genitourinary cancer, and congenital urinary tract abnormality were excluded. Eligible patients underwent urethrocystoscopy, and the findings were recorded. Associations between clinical risk factors and abnormal findings were analyzed.
Of the 88 patients (mean age of 48 years), who underwent urethrocystoscopy, urinary tract abnormalities were reported in 36 (40.9%) patients, among whom 19 (21.5%) and 17 (19.4%) had clinically significant and non-significant abnormalities, respectively. Significant abnormalities included 14 cases of urethral stricture, one case of mesh erosion into the urethra, one case of periurethral gland abscess, two cases of bladder diverticulum, and one case of refluxing ureteral orifice.
Although the majority of urinary tract abnormalities among females with recurrent urinary tract infection could be identified via imaging modalities, yet, it seems that cystoscopy is an appropriate method for the diagnosis of urinary tract disorders in some cases, especially in patients, who are unresponsive to common treatment strategies.

Ultrasound is the primary modality for the evaluation of patients with acute scrotum. Accurate exclusion of testicular torsion is prevented from unnecessary surgical exploration.
We assessed scrotal changes in pediatric testicular torsion in comparison epidydimits, with purpose to determine more specific points for differentiation testicular torsion from epididymitis.
During 2011 - 2017 a descriptive case control study was performed in Dr. Sheikh and Akbar Children hospital, Mashhad medical university of science. The 41 pediatric patients with acute scrotum (21 cases with testicular torsion and 20 cases with epididymitis) were examined. Eventually, the sonographic findings were analyzed to compare the results.
Testicular and epididymal enlargement, hydrocele, the hyperemia of surrounding tissues and the scrotal skin thickening are observed in both epididymitis and torsion without any significant difference (P ≥ 0.05). Some other findings where observed in both groups with a significant difference (P ≤ 0.05) such as changes in echogenicity of testis and epididymis, abnormal testicular axis and spermatic cord changes are observed in both epididymitis and torsion; but they had low sensitivity. The most specific signs of testicular torsion were testicular parenchymal heterogenicity (94%), testicular flow pattern (94%), increased echogenicity of epididymis (73%), heterogenicity of epididymis (84%), abnormal epididymis location (100%), mass-like configuration of epididymis (100%) and epididymis flow pattern (100%). The most epididymal findings are more specific and sensitive than testicular findings.
Avascularity, heterogenicity, displacement and mass-like configuration of epididymis are reliable sonographic findings for differentiation testicular torsion from epididymitis. They have high diagnostic value with sensitivity of 75% - 100% and specificity of 84 - 100%. So, making proper use of them can minimize diagnostic pitfalls.

Nowadays hypertension (HTN) is a common finding in children. Also, hydronephrosis is a common clinical condition that is referred to physicians. Kidney disease is the most common reason of secondary HTN in children.
In this study, the researchers aimed at evaluating the relationship between HTN and hydronephrosis in children.
This was a case-control study that was done on children older than four years old. The case group included children with hydronephrosis that referred to the pediatrics clinic of Amirkabir hospital in Arak, Iran. At the same time, healthy children with the same demographic condition were entered in the control group.
This study was done on 328 children in case (108 children: 42 males and 66 females) and control (220 children: 98 males and 122 females) groups. The mean age of these children was 7.52 ± 2.48 years old. Overall, 95.4% of the case group and 85% of the control were in the normal range of diastolic blood pressure (P-value = 0.013) and 99.1% of the case group and 89.5% of the control group were in the normal range for systolic blood pressure (P-value = 0.007).
It could be concluded that hydronephrosis and HTN had a relationship.

Renal colic is one of the most prevalent diagnoses made in emergency departments. Main medications used to relieve renal colic is opioids and non-steroidal anti-inflammatory drugs (NSAID). As far as these medications may have some side effects, researchers have always focused on proposing analgesics with more efficacy and less side effects. In the present study, it was tried to compare paracetamol and intravenous morphine plus diclofenac in renal colic.
In this single-center double-blinded randomized clinical trial, a total of 180 18 - 65 years old patients with definite diagnosis of renal colic with documented renal system calculus attending emergency department of Emam Reza educational-clinical center, Tabriz-Iran were included. These patients were randomly divided into two control and intervention groups, where the control group received intravenous morphine plus diclofenac and intervention group received intravenous paracetamol. Then, patients’ pain was measured using visual analog scale 0, 10, 20, 30, minutes and 24 hours after administration of medications and compared with each other. In this study, SPSSTM Version 15 was used for statistical analysis.
There was no statistically significant difference between the two groups. Difference between patient’s pain severity in intervention and control groups was not statistically significant, however, both groups experienced statistically significant reduction in pain severity from a time stage to another (P Based on the present study, paracetamol may be proposed as an effective alternative for routine medications in treatment of renal colic, due to the fact that it has comparable efficacy in pain reduction with opioids and NSAIDs as well as has less side effects.