Iranian Journal of Kidney Diseases
Volume:13 Issue: 5, Sep 2019

Chronic kidney disease (CKD) is a common disease in the world that has adverse outcomes. Immune system and its components have important role in the initiation, progression and complications of this disease by systemic inflammation. Regarding the role of kidneys in the body’s natural homeostasis and its relationship with other organs, CKD causes impairments in other organs. Patients with chronic renal failure have variety of complications, such as cardiovascular disease, anemia, bone disorders, immune dysfunction and etc., together which culminate in the morbidity and mortality of these patients. Immune dysfunction is one of the most important and serious complications in CKD patients. These patients often suffer from immune suppression and are susceptible to some infections. In this review, we describe some major findings of interactions between the kidney and immune system in CKD

 Percutaneous kidney biopsy has been established as a safe, reliable and minimally invasive method for diagnosing abnormalities. This study aims to describe the author’s experience with biopsy of the kidney and to compare the results between sitting and prone position in terms of the safety and relevant complications.

Patients were divided into two groups: prone and sitting position based on the clinician’s and patient’s preferences for the biopsy. Followed by kidney biopsy, its relevant complications were analyzed in both groups. Then, data and the mean number of obtained glomeruli in each group were compared.

Apart from sweating, presumably due to the prone position, no significant differences were found regarding the side effects including dizziness, seizure, nausea, and vomiting between the two groups. The number of obtained glomeruli was not significantly different between prone and sitting position.

In comparison with the prone position, kidney biopsy at sitting position is a good choice of procedure at least for patients who could not tolerate prone position. We recommend sitting position for kidney biopsy owing to the lower side effect and more comfortable experience for many patients. However, clinician may probably become a bit uncomfortable with this position.

 Contrast-induced nephropathy (CIN) is the most common cause of iatrogenic acute kidney injury, happens more commonly in patients with underlying kidney diseases. It has been shown that oxidative stress is the main mechanism of contrast nephropathy. Curcumin is suggested as an herbal antioxidant agent, thus we decided to assess the effect of curcumin in preventing this complication in patients with underlying chronic kidney disease who need coronary angiography.

 We conducted double blind, placebo-controlled clinical trial in 60 moderate to severe CKD patients who underwent coronary angiography or angioplasty. Adjusted dose of Iodixanol was used as contrast agent in all of them. Curcumin or placebo administered orally, 1.5 g daily from 2 days before procedure to 3 days after it. CIN was defined by an increased serum creatinine ≥ 0.3 mg/dL or an increase to ≥ 1.5 times of the baseline within 48 hours after procedure.

CIN occurred in 12 (20%) of patients, 5 (16.7%) in Curcumin group and 7 (23.3%) in placebo group (OR = 0.56, 95% CI = 0.18 to 2.36; P > .05). Serum Creatinine was increased after 72 hours of intervention from 1.65 ± 0.26 mg/dL to 1.79 ± 0.33 mg/dL in Curcumin group and from 1.61 ± 0.23 mg/dL to 1.86 ± 0.35 in placebo group. No significant difference was seen between the mean increase of serum creatinine in two groups (difference of 0.006 mg/dL, 95% CI = - 0.06 to 0.08; P > .05). Conclusion. Prophylactic oral Curcumin could not show protective effects on CIN in high-risk patients who have undergone coronary procedures

Acute kidney injury (AKI) in the newborn infants is associated with increased mortality and morbidity. The purpose of this study was to investigate the prevalence, risk factors and outcome of AKI in the premature neonates.

 Between January 2014 and January 2015, 206 premature neonates between 27 and 36 weeks gestations were studied in the newborn intensive care unit of Amir-AL Momenin Hospital, in Semnan, Iran. All neonates were followed-up for seven days after birth. The diagnosis of AKI was based on urine output (UOP) < 1.5 mL/kg/h for 24 hours and serum creatinine SCr > 0.3 mg/dL or increased by 150% to 200% from baseline value. Data collected included gestational age, gender, birth weight, first, and fifthminutes Apgar scores, use of mechanical ventilation, continuous positive airway pressure (CPAP), sepsis, congenital heart disease, and respiratory distress syndrome (RDS).

Gestational age (OR = 12.09, 95% CI = 3.51-41.63; P < .001), the use of mechanical ventilation (OR = 6.72, 95% CI = 1.44-31.41; P < .05), and the first and fifth minutes Apgar scores (OR = 0.65, 95% CI = 0.44-0.95; P < .05) were significantly related with AKI occurrence. Presence of congenital heart disease, sepsis, birth weight and RDS also had a significant relationship with AKI development (P < .05). Conclusion. The most important risk factors associated with AKI development were prematurity and low-birth weight, low 1 and 5 minutes Apgar scores, and the need for mechanical ventilation, as well as the coexistent of sepsis

 Atypical hemolytic uremic syndrome (aHUS) is associated with mutations or antibodies that affect the regulation of the alternative complement pathway. Several studies were published recently, describing these mutations. We present the initial clinical findings, treatments, and long-term follow-up results of 19 patients hospitalized with the diagnosis of aHUS.

Nineteen patients who were diagnosed as aHUS were enrolled from January 2010 to March 2017. Initial clinical signs and clinical follow-up of patients with aHUS were evaluated. The reasons for complement factor H (CFH) mutations were investigated.

CFH mutations were detected in 5 of the 19 aHUS cases. Of these, one was novel, while four were previously reported. We reported here the clinical course of aHUS patients with CFH previously defined mutations (p.Glu936Asp, Val 1197Ala) and a novel mutation (Glu927Lys), which caused previously defined aHUS. Two of the CFH mutation cases developed end-stage kidney disease that required hemodialysis, and one patient developed chronic kidney disease. Two cases were in remission; one of them under supportive therapy and the other one in remission with eculizumab treatment.

Morbidity rates are higher in children with aHUS. However, renal prognosis and morbidity rates are higher in children with CFH mutations than other children with aHUS. Poor prognosis in aHUS-children with CFH mutation depends on the genetic background

 Nephrotic syndrome (NS) is a common pediatric renal disorder. Most of these patients are steroid responsive. 10%–20% of children with new onset NS are resistant to steroid therapy. Patients who are resistant to steroids have limited treatment options such as calcineurin inhibitors (CNIs), mycophenolate mofetil (MMF), and rituximab. Despite several studies had documented that tacrolimus is superior to cyclosporine A (CsA) and MMF in treating SRNS but no study was conducted to prove the efficacy of tacrolimus in treating CsA and MMF resistant NS in pediatric populations. The study objective was to evaluate the role of tacrolimus in treating refractory idiopathic nephrotic syndrome.

 One hundred and twenty patients with idiopathic nephrotic syndrome were included in the study. Patients with steroid resistant NS were given cyclosporine (CsA) (first step protocol). In patients with cyclosporine resistant NS a combination of CsA+ MMF was given as a second step protocol. Unresponsive patients received tacrolimus as a third step treatment protocol. Tacrolimus was given at a starting dose of 0.1 mg/kg/d then the dose was modified according to serum trough levels and patients were followed up for 12 months to evaluate the outcome.

 Out of 120 patients, 15 cases were both cyclosporine and MMF resistant and received tacrolimus. Tacrolimus had induced remission in 11 (73.3%) patients during the first 6 months of therapy. Eight patients achieved complete remission and three patients reached partial remission.

Tacrolimus is effective in treating refractory multidrug resistant NS with favorable outcomes in childhood onset NS

 Currently, conflicting evidence exists among community-based studies as to whether chronic kidney disease (CKD) is a cardiovascular (CVD) risk equivalent. We aimed to evaluate the effect of CKD on CVD based on a large trial results.

To perform a secondary analysis, we obtained the data of SPRINT trial from NHLBI data repository center. 2646 subjects with baseline CKD and 6715 without CKD were enrolled. A composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes was considered as primary outcome.

Throughout the 3.21 years of follow-up, presence of CKD, compared to those without CKD, negatively affected the primary outcome (incidence rate, 2.84% per year vs. 1.55% per year in patients with and without CKD, respectively; Hazard ratio, 1.83; 95% CI, 1.49 to 2.11; P < .001). This finding was consistent across all the secondary outcomes. However, the risk was not as great as those with clinical cardiovascular disease (incidence rate, 4.13% per year). Presence of CKD was the strongest predictor of developing AKI with intensive blood pressure reduction, increasing its chance by 215%.

SPRINT is the first trial revealing that CKD is an independent risk factor for CVD. However, CKD could not be considered as a CVD risk equivalent. In the presence of CKD, with intensive blood pressure reduction the chance of AKI is dramatically increased.

Systemic lupus erythematosus (SLE) in children is associated with renal involvement in majority of cases. While glomerular involvement is a common manifestation, tubular involvement is rare. Tubular dysfunctions previously described with SLE are renal tubular acidosis (Type 1 and less commonly type 4). Isolated renal tubular acidosis without glomerular involvement has not been reported in childhood SLE. We report an adolescent girl with SLE, autoimmune thyroiditis and distal RTA who subsequently developed autoimmune hemolytic anemia. During a follow-up of almost 7 years the girl never developed any proteinuria while the RTA persisted. Also during this period, her mother was diagnosed with SLE manifesting with thrombocytopenia

Sarcoidosis is a systemic disorder affecting multiple organs. We presented a 56-year old woman with renal impairment who was diagnosed with sarcoidosis accompanied by IgA nephropathy. Treatment with methylprednisolone was started for the patient. After treatment, the patient was discharged with good general condition and resolved proteinuria