فهرست مطالب

Nephro-Urology Monthly - Volume:11 Issue:3, 2019
  • Volume:11 Issue:3, 2019
  • تاریخ انتشار: 1398/07/10
  • تعداد عناوین: 7
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  • Farideh Hasavari , Zahra Atrkar Roushan, Asieh Sedighi, Mehrnaz Asgharnezhad* Page 1
    Background

    Protein-energy malnutrition, one of the most important risk factors for cardiovascular diseases, is common in dialysis patients. In this way, several characteristics and socio-economic factors could influence nutritional stats. The diagnosis of malnutrition and its related factors can assist the healthcare team in planning for the care of hemodialysis patients.

    Objectives

    In this study, we are aimed to determine the nutritional status among hemodialysis patients and characteristics and also socio-economic factors.

    Methods

    In this cross-sectional study, 312 patients were selected randomly. Modified subjective global assessment (SGA) tool was used for data collection. The data was expressed as mean ± SD and frequency. Logistic regression analysis was performed to detect predicting factors of malnutrition using SPSS software.

    Results

    About 65.1% of hemodialysis patients suffered from mild-to-moderate malnutrition and 15% of patients were severely malnourished. Most patients were married (82.7%), low- income (63.1%), illiterate (63.8%) and employed (52.2 percent). Following the subgroup analysis, we found significant weight changes in malnourished patients (P value = 0.000). In addition, we found that severely malnourished patients were older, married or divorced, unemployed and lived in large families compared with other groups (P value < 0.05). The illiterate people were in greater risk for malnutrition (AOR = 8.14, 95% CI: 1.8 - 36.89).

    Conclusions

    Socio-economic factors such as income, education, living conditions, marital status, family size and employment affect nutritional status. Therefore, taking socio-economic factors into account can help the treatment team in the care of hemodialysis patients.

    Keywords: Malnutrition, Renal Dialysis, Patients
  • Alireza Lashey , Said Yaghoob Sehri , Ahmad Aghai Meibodi , Mahyar Ghafari , Jafar Gholivandan, Mohamad Solymani, Mahmood Bakhtiyari * Page 2
    Background

    Given the popularity of prostate specific antigen (PSA) testing in recent years, the number of patients undergoing diagnostic prostate biopsy has increased. The transrectal ultrasound-guided (TRUS) biopsy is considered as the gold standard for prostate cancer detection, although has a low sensitivity.

    Objectives

    The current study aimed at enhancing prostate cancer diagnosis using MRI-TRUS fusion biopsy in patients with negative history of TRUS biopsy.

    Methods

    In the current study, patients undergone TRUS prostate biopsy with benign results that were candidates for repeat biopsy were recruited. After making the preparations, patients underwent magnetic resonance imaging (MRI)-TRUS fusion biopsy. Gleason score, the number of involved cores, perineural invasion, perilymphovascular invasion, and the percentage of core involvement were recorded.

    Results

    Of the 191 patients, 70 (36.6%) had positive biopsies. The frequency of non-detectable cancers by targeted biopsy based on the level of cancer risk showed that at the very high-risk level, five (29.4%) and at high-risk level, two (11.7%) subjects were not recognized. The mean Gleason score in targeted (7.47±0.99) and random (7.13±1.04) positive biopsies showed a significant difference between the two groups (P = 0.045). Targeted biopsies are better than random ones to detect high-risk (33.9% vs 29.2%, P = 0.013 respectively) and very high-risk cancers (45.3% vs. 41.5%, P = 0.05 respectively).

    Conclusions

    The combination of both biopsy approaches is suggested to offer a reliable method with high rate of tumor detection.

    Keywords: Prostate Cancer, MRI-TRUS, TRUS Fusion Biopsy, Biopsy
  • Pantipa Tonsawan , Anucha Puapairoj , Chitranon Chan On , Sirirat Anutrakulchai , Kittrawee Kritmetapak , Cholatip Pongskul , Dhavee Sirivongs , Kittisak Sawanyawisuth* Page 3
    Background

    Lupus nephritis (LN) is the most common etiology of secondary glomerulonephritis. Several studies have identified the risk of LN in SLE patients. However, clinical factors predictive of LN in patients who underwent kidney biopsy for the first time was limited if there was no previous history of SLE.

    Objectives

    This study aimed to investigate the clinical factors predictive of LN by kidney biopsy regardless of SLE history.

    Methods

    We conducted a retrospective study between January 2012 and May 2013. The inclusion criteria were adults over 18 years old who underwent the first kidney biopsy in their lives. Participants were divided into two groups according to renal pathology (LN and non-LN group). Predictors for LN in those without history of SLE were executed by using by logistic regression analysis.

    Results

    In total, there were 205 patients included in the study. LN was defined in 68 patients (33.2%) and the other 137 patients (66.8%) were non-LN. The LN group had a significantly lower mean age (33.6 years vs. 44.2 years; P value < 0.01) and higher eGFR (79.0 vs. 62.3 mL/min; P value 0.05) than the non-LN group. After adjustment, only three factors were independently associated with LN, including eGFR, history of SLE, and RBC in urine > 10 cells/HP. Without history of SLE, ANA was the only independent factor in predicting LN with ORs (95% CI) of 14.5 (1.4, 150.8).

    Conclusions

    ANA should be tested in all patients who underwent kidney biopsy regardless of previous history of SLE.

    Keywords: Glomerular Disease, Lupus Nephritis, Systemic Lupus Erythematosus, Kidney Biopsy, Clinical Factors
  • Nestor Fabian Pedraza *, Andrea Elena Garcia , Javier Antonio Amaya , Yenny Baez , Fernando Giron Page 4
    Background

    Different vascular control devices have been widely used in laparoscopic donor nephrectomy (LDN); within those, we find the non-absorbable polymer ligating (NPL) clip and vascular stapler (VS). Although some warnings have been reported due to hemorrhagic events secondary to the use of NPL clips, some transplant groups have shown studies that support the safe use of NPL clips for renal artery and vein control during LDN (1).

    Objectives

    This study aimed to describe the experience of a transplant center where we evaluate the safety of the use of NPL clips in LDN.

    Methods

    A total of 500 nephrectomies were performed in our center from July 2003 to July 2017. In all procedures, vascular control was done by placing two proximal NPL clips both in the artery and left renal vein or two NPL clips in the renal artery and a VS in the right renal vein. The data were obtained retrospectively from the records of clinical data. Demographic analysis and perioperative variables were described separately for both of the NPL and VS groups.

    Results

    Vascular control was performed with VS in 68 patients (13.6%) and with NPL clips in 431 patients (86.3%). Operating room time, intra-operative bleeding, and hospital stay were similar in both groups without finding a significant difference in the proportion of complications. There was no bleeding or donor loss caused by NPL clips at intraoperative, perioperative, and postoperative periods in the cases who underwent nephrectomy using the two methods.

    Conclusions

    Our results support the advantages, security, efficacy, and low cost of the use of NPL to control renal vessels during laparoscopic nephrectomy.

    Keywords: Vascular Control, Ligating Clip, Donor Nephrectomy, Hand-Assisted Laparoscopy
  • Kien Nguyen Trung*, Ha Do Manh, Kien Truong Quy , Tran Pham Van, Mao CanVan, Nghia Vu Xuan, Dung Nguyen Huu, Hien Nguyen Thi Thu, Nam Thai Thien, Lien NguyenThi Thuy , Huong Nguyen Thu Page 5
    Objectives

    The current study aimed at evaluating the predictive value of serum IgG and IgG/IgM ratio measured on admission for steroid-resistant response after eight weeks of treatment in pediatric patients with idiopathic nephrotic syndrome (NS).

    Methods

    The current cross sectional study was conducted on 69 children, including 41 patients with idiopathic NS and 28 healthy subjects as controls. Serum IgA, IgG, and IgM levels were measured in all subjects using immunoturbidimetric method.

    Results

    The median serum IgA, IgG, and IgM levels were 1.15, 2.23, and 1.7 g/L, respectively. Serum IgA and IgG levels in patients were lower than controls (P < 0.001). In addition, 46.3% of children had steroid-resistant nephrotic syndrome (SRNS). IgG had a positive predictive value for SRNS (area under the curve (AUC) = 0.923, P < 0.001). With the cutoff point of 2.04 g/L, this test had the sensitivity and specificity of 89.5% and 95.5%, respectively. The IgG/IgM ratio also had a positive predictive value for SRNS (AUC = 0.892, P < 0.001). With the cutoff point of 1.64 g/L, this test had the sensitivity of and specificity of 89.5% and 81.8%, respectively.

    Conclusions

    Serum IgG level and IgG/IgM ratio can be considered as predictive markers for steroid resistance in children first diagnosed with idiopathic NS.

    Keywords: Idiopathic Nephrotic Syndrome, Children, Serum IgG Concentration, IgG, IgM Ratio, Steroid-Resistance
  • Pantea Tajik, Amir Hossein Goudarzian, Zeinab Pourzahabi * Page 6
    Introduction

    Arthrogryposis-renal dysfunction-cholestasis (ARC) syndrome is a rare disorder that affects several organs.

    Case Presentation

    In this case report, a 45-days-old infant with ARC is introduced. The findings revealed different anomalies in different organ systems. He received supportive treatment, including Shohl’s solution or bicitra for treating acidosis, and fat-soluble vitamins (A, D, E, K), multivitamins and MCT oil.

    Conclusions

    More attention must be paid to patients with arthrogryposis-renal dysfunction-cholestasis (ARC).

    Keywords: Arthrogryposis, Kidney, Syndrome, Case Report
  • Bita Geramizadeh*, Leila Karami , Azalia Aminzadeh, Kurosh Kazemi , Alireza Shamsaeefar Page 7

    Metastatic carcinoma to the epididymis is a very rare occurrence. Since the last 20 years, there have been only 13 cases reported in the English literature so far. The majority of the previous case reports presented with scrotal swelling and the most common primary carcinoma metastatic to epididymis has been prostatic adenocarcinoma. The size of the tumors has been small and below 5-cm. The age range has been 50 to 77 years. Herein we report the largest reported metastatic carcinoma to the epididymis (6-cm) in the youngest patient reported (36-year-old). Also, the second case of metastatic cholangiocarcinoma to the epididymis.

    Keywords: Cholangiocarcinoma, Epididymis, Metastasis