Iranian Journal of Kidney Diseases
Volume:14 Issue: 1, Jan 2020

Urinary tract infection (UTI) is common among pediatric population. Pyelonephritis, especially in young infants, is associated with a significant morbidity. Usually, clinical manifestations, laboratory findings, and imaging are used to differentiate between lower and upper UTI. Lack of specific clinical findings and commonly used nonspecific blood indices are important hamper differentiation between lower and upper UTI in early stages. Imaging techniques are neither cost benefit nor safe for detection of UTI. Recent efforts have focused on characterization of novel serum and urinary biomarkers for early detection of acute pyelonephritis in children. It seems that urinary NGAL, NAG, TNF-α and IL-8 may be used as novel markers for early diagnosis of acute pyelonephritis in children.

Whether working in intensive care unit or not as nephrologists we are all facing complicated cases with different sign and symptoms. Among them is a category of patients presenting with concomitant respiratory and kidney failure called pulmonary renal syndrome, which needs mutual connection between nephrologist and pulmonologist closely for the best decision-making. Although this is not a common entity, still associated with high rate of morbidity and mortality involving diffuse alveolar hemorrhage and glomerulonephritis. Understanding the updates in the field of management would benefit both the patients and caregivers providing clear answers to present obstacles.

No large study has been conducted on biopsy-proven nephropathies. Our aim was to report clinical and pathological pattern of kidney disease diagnosed by kidney biopsy in our center. This is a retrospective study on kidney biopsy during 7 years; we analyzed the results of kidney biopsies and their clinical data. Data were analyzed by SPSS 18.0 and a P < .05 was considered. In 1355 kidney biopsies (55.7% women, age = 33.2 ± 16.4), primary glomerulonephritis (GN) was the main feature (57.1%). The most common presentation was asymptomatic urine abnormality (32.3%). Lupus nephritis (24.5%), membranous GN (17.0%), and focal segmental glomerulosclerosis (13.9%) were the most frequent diagnosis. This study highlights the histopathological patterns of kidney disease in southern Iran. lupus nephritis, membranous GN, and focal segmental glomerulosclerosis are currently the three major diseases. These results have an important role in organizing renal health plans as an initial phase in our population

Membranous glomerulonephritis (MGN) is the most common cause of nephrotic syndrome in adults. The gold standard techniques for diagnosis of MGN are based on a constellation of findings given by light microscope, electron microscope (EM), and immunofluorescence (IF). Occasionally, only formalin-fixed tissues are available for the analysis by light microscopy, which have limitations in differentiating minimal change diseases from MGN. Recently, the usage of C4d immunohistochemistry (IHC) has been proposed for the diagnosis of MGN. The aim of this study was to evaluate the accuracy of C4d-IHC in diagnosis of MGN.

The present investigation conducted on patients with nephrotic syndrome who underwent renal biopsy in Labbafinejad hospital, from 2016 to 2017. The entire specimens were examined by light microscope, immunofluorescence, and electron microscope as a gold standard method for diagnosis of MGN. The samples were then stained for C4d immunohistochemical analysis. Eventually, the sensitivity, specificity, positive, and negative predictive value for C4d-IHC was determined.

The sensitivity and specificity of the C4d-IHC in order to differentiate MGN from other glomerulopathies were 95% and 87.5%, respectively. In addition, the negative and positive predictive values were 97.2% and 79.16%, respectively.

 It was ultimately attained that C4d-IHC has more accuracy in identification and diagnosis of MGN, in contrary to EM and IF, this method is more usable and cost effective, which requires a lower level of skill and advanced equipment. Indeed, this technique does not require fresh specimen.

 Contrast induced nephropathy (CIN), a well-known complication of using radio contrast media, dramatically increases the likelihood of patient morbidity and mortality following coronary angiography. As there is no specific treatment for CIN, prevention could be the best strategy to address this issue. Since now, the only approved preventing strategy was hydration with normal saline while antioxidant agents as a new yet unapproved remedy for this purpose could be applied .The present study was conducted to examine the effect of alpha tocopherol in CIN prevention.

This prospective controlled trial was carried out on 201 patients with chronic kidney disease (eGFR < 60 cc/min) underwent coronary angiography. We assigned three groups of CKD patients: 72 patients who received prophylaxis administration with isotonic saline (Group A), 66 patients with isotonic saline plus N-acetylcysteine (1200mg twice a day) for 2 days (Group B) and 63 patients who received isotonic saline plus daily alpha tocopherol (600 IU once daily from one day before till 2 days after angiography) for 4 days (Group C). The contrast media in all three groups was nonionic iso-osmolal agent, Visipaque.

Even though CIN didn’t developed in any of the three aforementioned groups but there was statistically significant reduction in eGFR from baseline in all three groups (P < .001). Moreover, We found no statistically significant difference in GFR reduction between three studied groups.

Administration of alpha tocopherol has no additive beneficial effect over isotonic saline in CIN prevention in CKD patients

 This study was conducted to compare parameters of kidney injury, oxidative stress and inflammation in people with diabetic nephropathy (DN) and type 2 diabetes mellitus (T2DM).

In a cross-sectional study, 57 cases with DN and 57 cases with T2DM were included in the study. Fasting blood samples were obtained to determine parameters of kidney injury, oxidative stress and inflammation.

The current study showed that patients with DN had higher tumor necrosis factor-α (TNF-α) (167.0 ± 40.1 vs. 151.4 ± 37.4 ng/L, P < .05) and matrix metalloproteinase-2 (MMP-2) concentrations (1625.2 ± 631.0 vs. 1391.5 ± 465.4 ng/mL, P < .05) compared with T2DM cases. Moreover, we observed a non-significant increase in MMP-9 levels among patients with DN compared with individuals with T2DM (4864.4 ± 1934.3 vs. 4239.2 ± 1853.9 ng/L, P > .05). Furthermore, advanced glycation end products (AGEs) levels in patients with DN were higher than that of patients with T2DM (8511.7 ± 1799.9 vs. 7660.7 ± 1711.9 AU, P < .05), but the difference in malondialdehyde value was not significant. Finally, we found that total protein levels in cases with DN were enhanced compared with individuals with T2DM (7.1 ± 0.5 vs. 6.9 ± 0.6 mg/dL, P < .05); however, other markers of kidney injury did not change.

In conclusion, the results of present study revealed that few markers of inflammation and oxidative stress including TNF-α, MMP-2, AGEs levels and total protein levels in patients with DN were significantly higher than that of patients with T2DN. Further studies are necessary to confirm these findings.

A vast range of factors cause adverse outcomes after coronary surgery. The goal of this study was to figure out if there was a relation between large volumes of fluid balance in patients who underwent coronary surgery and common complications after CABG.

130 candidates for on-pump CABG were enrolled in our study at Rajaie Cardiovascular Medical and Research Center in 2016. After calculating balance volume for each patient, they were divided into 3 groups; Group (1): fluid balance < 2000 mL, Group (2): fluid balance 2000-3000 mL, Group (3): fluid balance > 3000 mL. Some of the post-surgery complications were studied in these 3 groups. Since in similar studies, fluid overload has been investigated based on the patient’s weight gain after surgery or only on the basis of the patient’s fluid intake, we designed a study based on an accurate fluid balance measurement, which included the subtraction of the patient’s outputs and losses from their intakes.

Logistic Regression showed that fluid balance > 3000ml was the predictor of long mechanical ventilation [ (Odds Ratio (95% CI) = 4.6 (1.9 - 11.5), P < .05], more than 3 days of ICU stay [(Odds Ratio (95% CI) = 3.2 (1.09 - 9.6), P < .05], and longer hospital stay [Odds Ratio (95% CI) = 5.2 (1.9 - 14.08), P < .05]. There was no significant relation between AKI and fluid balance.

Administration of large fluid volumes in CABG patients would lead to fluid accumulation and independently associated with prolonged mechanical ventilation, longer ICU stays and extended hospital stays.

 Understanding the factors affecting the survival of patients undergoing hemodialysis is the mainstay of care in this population. The present study aims at finding these features using novel cure models that discover factors important in both long term and short-term survival of patients undergoing HD.

 Data were retrospectively collected from the database of Shiraz University of Medical Sciences Special Diseases Administration including patients of 34 HD centers during 2011 to 2015. The primary outcome was death. Considering people with no death event as cured, the rest of the patients considered as uncured. To evaluate the factors affecting mortality, we used a mixture cure model (MCM) that model the long-term and short-term survival of patients separately.

Of 506 patients, 68.75% of women and 75.0% of men were long-term survivors. The mean (± SD) age of the patients was 57.5 (± 16.5) years and the empirical value of the cure rate was 72.9%. Sex, age, and Kt/Vurea were recognized as important factors in the long-term survival. In other words, lower age, male sex, and Kt/ Vurea ≥ 1.2 significantly increased the odds of being cured. The factors effective in short-term survival were mean corpuscular hemoglobin concentration (MCHC) and serum hemoglobin. The serum hemoglobin between 11 and 12.5 and a high MCHC decreased the risk of death.

 Using cure model survival analysis, it was found that factors affecting the proportion of the patients with long-term survival might be different from those affecting short-term survival.

 Hemodialysis (HD) patients are considered as a high-risk population for cardiovascular disease, within which morbidity and mortality have been determined to be associated with dyslipidemia, pro-inflammatory cytokines, increased levels of C-reactive protein (CRP), and adhesion molecules (ICAM-1, VCAM-1). Different markers have been investigated to detect inflammation in hemodialysis patients, as well as the prognostic values of these markers.

The present study aimed to investigate the effect of nano-curcumin (120 mg) over 12 weeks on hs-CRP levels, adhesion molecules (ICAM-1, VCAM-1), and serum lipid profiles on hemodialysis patients in a randomized controlled clinical trial.

The results revealed that the mean serum hs-CRP level in the nano-curcumin group exhibited a decrease by the end of the study, when compared to mean serum hs-CRP level in the placebo group. However, this intra-group trend was not found to be statistically significant (P > .05). Nevertheless, a significant difference was determined between the values in the group receiving nano-curcumin, in comparison with the placebo group, at the end of the study (P < .001). Based on the attained results, mean serum levels of VCAM-1 in the nano-curcumin group were significantly reduced at the end of the study, compared with the placebo group (P < .001). Furthermore, the intra-group changes comparison showed significant reductions in serum levels of ICAM1 in patients treated with nano-curcumin at the end of the study (P < .05). Additionally, though decreases in mean triglycerides, total cholesterol, LDL-C were noted, there were no statistically significant intra-group differences (P > .05). Moreover, intra-group changes comparison of HDL-C levels and fasting blood sugar did not show any significant changes.

The current study indicates that nano-curcumin may show beneficial effects in lowering inflammation and hs-CRP levels, as well as adhesion molecules (ICAM-1, VCAM-1), in hemodialysis patients. However, the evidence is still insufficient.

As a rare and normally-benign and functionless tumor, primary adrenal myelolipoma comprises adipose tissue and myeloid cells, and its diagnosis is usually difficult owing to its asymptomatic nature. Imaging techniques can detect these masses in over 90% of the cases. CT scan is the most sensitive imaging technique, which can display the tissue nature of this tumor with a high resolution. The present case report involves a 45-year-old woman with bilateral adrenal myelolipoma diagnosed with imaging methods

Bartter’s syndrome is a rare disorder usually presenting antenatal or in childhood and is characterized by hypokalemia, metabolic alkalosis, hyperaldosteronism and normal blood pressure. We report a case of adult-onset Bartter’s syndrome in a 38 year old male who presented with lower limb weakness.