Iranian Journal of Kidney Diseases
Volume:14 Issue: 3, May 2020

Coronaviruses primarily cause zoonotic infections, however in the past few decades several interspecies transmissions have occurred, the last one by SARS-CoV-2, causing COVID-19 pandemic, posing serious threat to global health. The SARS-CoV-2 spike (S) protein plays an important role in viral attachment, fusion and entry. However, other structural and non-structural SARS-CoV-2 proteins are potential influencers in virus pathogenicity. Among these proteins; Orf3, Orf8, and Orf10 show the least homology to SARSCoV proteins and therefore should be further studied for their abilities to modulate antiviral and inflammatory responses. Here, we discuss how SARS-COV-2 interacts with our immune system.

HUS is a leading cause of AKI in infants. Though new classification of HUS is based on underlying disease, it traditionally defines as diarrhea positive (typical) and negative (atypical). We have no figure of the incidence and prevalence of HUS, the underlying disease and the outcome in Iranian patients. This meta-analysis of Iranian studies deals with this matter. We used relevant medical search engines and national databases from 1985 to 2019. We searched manually to detect admissible cross references. All studies assessed for the aspects and the risk of distort by three appraisers. Metaprop package of STAT applied to calculate point prevalence, proportion, and incidence with 95% confidence intervals. A total of 27 articles and one abstract of congress containing 7084 cases met all the inclusion criteria and qualified for the final analysis. Considering 1397 patients with HUS over 33 years of study, the pooled prevalence was 28% (95% CI: 15 to 44) and 18.38 pmp (0.55 pmp/y). In children less than 15 years, the prevalence was 79.82 pmp (2.41 pmp/y). Between 1985 and 2019, atypical HUS was identified in 488 patients with the prevalence of 27.88 pmp (annual prevalence of 0.84 pmp/y of children aged less than 15 years old). The incidence was 9.4 pmp (0.28 pmp/y), contributed to 9.9% (95% CI: 3 to 20) of AKI, and 5.48% (95% CI: 3.5 to 7.9) of CKD and ESRD. The rate of HUS diagnosis was increasing during the previous four decades. HUS consists of a significant number of AKI and ESRD. It needs further prospective longitudinal study.

 Knowing the national statistics of glomerular diseases will help in the management and minimizing their burden in the community. The aim of this study was to assess the overall distribution of subtypes of glomerulonephritis (GN) and the prevalence of renal diseases in a subgroup of diabetic and hypertensive patients.

This cross-sectional study was conducted on 860 patients with different subtypes of GN diagnosed by percutaneous renal biopsy and histological examination.

The most common subtype of GN was membranous GN (30.1%) followed by minimal change disease (20.1%), IgA nephropathy (9.5%) and Lupus nephritis (8.8%), as well as membranoproliferative GN (6.4%), focal segmental GN (5.6%), crescent GN (43, 5%), and DM nephropathy (36, 4.2%). IgA nephropathy and focal segmental GN were mostly common among maleswhile the most female dominant GN was Lupus nephritis. Lupus nephritis was the most common GN diagnosis among subjects who were younger than 29 years old (50%), while the diabetic nephropathy was the most common GN diagnosis among subjects who were older than 53 years old (44.4%). The most common GN among hypertensive subgroups was focal segmental GN (41.7%) followed by diabetic nephropathy (33.3%) whereas the most common subtypes of GN among diabetics was diabetic nephropathy.

The most common type of GN among Iranian population in Mashhadwas membranous GN and minimal change disease. The distribution of each subtype of glomerular disease depend on the baseline determinants including age, gender and hypertensive state.

 We assessed the urinary level of L-FABP in patients with APN and compared between patients with scar versus normal kidneys.

We enrolled children aged 2 months to 12 years old with APN. The urine concentration of L-FABP and L-FABP/Cr were measured. Patients divided into three groups; patients with scarring APN as group 1, patients with non-scarring APN as group 2, and controls.

79 children (aged 57.4 ± 40.5 months, (87.5%) female) enrolled in the study. Group 1 was composed of 19 (16 female) cases, group two 35 (32 female) cases, and group three 26 (2 female) healthy controls. There was no significant difference in absolute urinary level of L-FABP between APN groups and controls. Group 1 patients had a significantly higher concentration than group 2 (P < .05). The UL-FABP /Cr was significantly higher in group 1, than groups 2 and 3 [(0.28 ± 0.39 pg/mg, 0.08 ± 0.08 pg/mg, and 0.10 ± 0.09 pg/mg; respectively), (P < .05, P < .05)]. The difference between group 2 and 3 was not significant (P > .05). The sensitivity and specificity of UL-FABP /Cr ratio in prediction of scar was 50% to 72% and 44% to 56%, respectively.

The urinary ratio of L-FABP to creatinine is not a useful tool for diagnosis of APN or VUR but could be helpful in prediction of long-term potency to renal parenchymal scar formation.

 Curcumin is turmeric extract that have antiproliferative, anti-cancer, and anti-oxidant effects and has been shown that it may have reno-protective properties. This study conducted to evaluate the efficacy of curcumin in the prevention of CIN.

This randomized placebo-controlled clinical trial was carried out on 138 patients with chronic stable angina scheduled for elective coronary angiography that had renal insufficiency. Patients were randomized to receive curcumin or placebo in addition to standard hydration with saline 0.9% before nonionic iso-osmolar contrast agent administration for angiography. Serum creatinine was measured 12h before, 24h and 48h after contrast injection. CIN, mainly, defined as increase in creatinine of ≥ 0.5 mg/dL or ≥ 25% from the baseline.

Serum creatinine change was 0.19 ± 0.31 mg/dL which was 0.22 ± 0.33 and 0.16 ± 0.29 in placebo and curcumin group, respectively. In ‘repeated measure analysis’ no statistically difference was found in serum creatinine level between pre-intervention, and 24 hours and 48 hours after intervention. CIN was occurred less frequently, though statistically insignificant, in curcumin group (22.7%) compared with placebo group (32.3%).

It was found that although curcumin reduced the incidence of CIN, this difference was not statistically significant. It seems that, like other antioxidant substances studied in previous studies, although curcumin can reduce apoptosis and oxidative stress at cellular level, but in high risk patients for CIN, such as patients with renal insufficiency, it does not produce more protective effects than hydration with normal saline.

 Early diagnosis of acute kidney injury is critical for decision-making. Neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker introduced for early detection of acute kidney injury (AKI). We evaluated urinary NGAL level in hospitalized patients due to poisoning as a predictor of AKI.

We studied patients with poisoning due to various causes. Urinary NGAL and urine creatinine levels were measured. Serum creatinine levels were measured for all patients at baseline and after 24 and 48 hours. Then, a ROC curve developed for urinary NGAL, and cutoff point and accuracy of urinary NGAL test were determined.

Ninety hospitalized patients with acute poisoning were consecutively recruited into the study over an eight-months period. With the gold standard test (i.e., serum creatinine measurement), 21 patients were diagnosed with acute kidney injury (AKI) and 69 with non-AKI, whereas according to ROC curve, at a cutoff point of 110 ng/ml, urinary NGAL with an 81% sensitivity and 91.3% specificity distinguished 23 patients with AKI and 67 with nonAKI. The false positive and false negative values of urinary NGAL test were 8.7% and 19%, respectively. The positive predictive value and negative predictive value of urinary NGAL were estimated to be 73.9% and 94%, respectively.

Urinary NGAL test, with an AUC of ROC curve of approximately 90% and a sensitivity of 81%, can be used for early detection of AKI. It has a high specificity (91.3%), indicating that the percentage of false positive cases (8.7%) will be small.

 Fibroblast growth factor 23 (FGF-23) and its cofactor alfa klotho, are one of the most important factors, directly and indirectly, involved in the process of calcification and atherosclerosis. This study aimed to evaluate the efficacy of a combination of regular exercise during dialysis on quality of life and markers including FGF-23, alfa klotho, and fetuin-A levels.

Forty-five hemodialysis patients aged 61 ± 9.02 years and weight 69 ± 11.25 kg were randomly divided into two training, EX (n = 24) and control groups, CON (n = 21). The EX group patients participated in a 16-week combined aerobic and resistance exercise program during dialysis. Bone markers including, FGF-23, klotho, fetuin-A, were measured before and at the end of the study in both groups. Statistical analysis for comparing data change during study by SPSS software and the P value was set at .05.

In the control group in the secondary assessment, reduction in quality of life was observed (P < .05). Significant change in growth factor 23, CRP, and fetuin-A was not observed in exercise and control groups (P > .05), however significant rising of klotho was observed in treated patients (P < .05). Also, combined training reduced the amount of phosphorus, parathyroid hormone; significantly (P < .05).

This study showed that regular exercise during dialysis improves quality of life and physical functions. No significant change in FGF-23 and CRP were observed during the study. However significant rising of klotho and reduction of iPTH and phosphorous levels were observed in treated patients.

It is not known whether there are any differences in dialysis outcomes of hemodialysis patients on Monday, Wednesday and Friday (MWF) schedule and patients on Tuesday, Thursday and Saturday (TTS) schedules. Patients on TTS schedule who receive one of the treatments on weekends may have worse outcomes compared with patients on MWF schedule as a result of weekend effect. In this study we compared the mortality and clinical performance measures for hemodialysis care, between patients on these two different hemodialysis schedules.

This single center study was conducted on chronic hemodialysis patients above 18 years of age at the time of initiation of hemodialysis who were under thrice weekly hemodialysis treatment for at least 12 months. Mortality and hemodialysis related quality indices were retrospectively compared between patients on MWF or TTS schedules.

A total of 188 patients (114 male and 74 female) were included. The mean age of the patients at the start of dialysis was 50.9 ± 18.4 years and median hemodialysis vintage was 60.5 (12 to 369) months. Ninety-nine patients were on MWF schedule and 89 patients were on TTS schedule. More patients on MWF schedule reached the target laboratory values and patients on MWF schedule had a survival advantage compared with patients on TTS schedule.

Hemodialysis patients on MWF schedule may receive higher quality of care and may have better outcomes compared with patients on TTS schedule.

Loss of skeletal muscle mass and muscle strength is common in dialysis patients. Therefore, this investigation was designed to determine the association between body composition, muscle function, and physical activity with mortality in peritoneal dialysis (PD) patients.

This was a multicenter cohort study on all eligible PD patients (n = 79) in Tehran PD centers. At baseline, skeletal muscle mass and muscle strength were determined using bioelectrical impedance analysis and handgrip strength, respectively. Physical performance was assessed by a 4-meter walk gait speed test. Physical activity level was estimated by using the long-form International Physical Activity Questionnaire at baseline. The mortality of PD patients was evaluated two years after the start of this study.

The total dialysis adequacy was significantly lower in dead patients in comparison with live patients (P < .05). In contrast, serum hs-CRP (P < .05), and the total amount of glucose absorbed daily from PD solutions (P < .05) were significantly higher in dead patients in comparison with live patients. There were no significant associations between body fat mass, skeletal muscle mass, skeletal muscle mass index, muscle strength and physical performance with mortality in PD patients. However, in PD patients with physical activity ≤ median, odds of mortality was 7.4 times higher than those with physical activity > median (OR = 7.4, 95% CI: 1.3 to 43.3; P < .05).

 This study indicates that low physical activity; low dialysis adequacy, high serum hs-CRP, and high amount of glucose absorbed from PD solutions are related with high mortality in PD patients.

Since in the reports presented about COVID-19, patients receiving kidney transplantation have not been specifically studied and based on national flowchart, this population is classified as highrisk group, thus it is necessary to be aware of the step-by-step treatment approach of these patients. Suspicious cases included patients with a history of dry cough, chills or sore throat accompanying by shortness of breath with or without fever, patients with upper/lower respiratory symptoms with radiological manifestations as single or double-sided multilobular infiltrations on CT scan or plain chest radiography, any one that has a history of close contact with a definite COVID-19 case within the last 14 days, any one with a history of presence in COVID-19 epidemic regions within the last 14 days and patient with pneumonia that despite of proper treatment has an inappropriate clinical response and clinical condition becomes more severe in an unusual way or unexpectedly.

The initial manifestation of emphysematous pyelonephritis (EPN) with hiccups is extremely rare. We report a 47-year-old diabetic man with complaint of persistent hiccups as the first manifestation. Class 3B EPN was confirmed based on findings of Contrast-enhanced abdominal multi-slice CT scan. There were no neurologic deficits, Medications that lead to hiccups and gastrointestinal dysfunction. Our patient was treated with antimicrobial therapy and double J stenting. His hiccups completely resolved in one week and had no relapse.

During the COVID-19 pandemic, we had a 25 years old male case without any underlying disease or history of autoimmune disease in COVID-19 Clinic, Isfahan, Iran. He presented with arthralgia and weakness so we started COVID-19 therapeutic regimen. In his hospitalization, creatinine increases and abnormalities in random urine sediment was seen. Methylprednisolone and cyclophosphamide were prescribed due to suspected glomerulonephritis. After renal biopsy the diagnose was confirmed as crescentic proliferative glomerulonephritis. The patient also, underwent plasmapheresis and intravenous immunoglobulin injection. He was discharged healthy without development of new pulmonary symptoms despite immunosuppressive treatment.