Nephro-Urology Monthly
Volume:13 Issue: 2, May 2021

The transforming growth factor-beta 1 (TGF-β1) has been demonstrated as one of the main factors in the progression of fibrosis and sclerosis glomerular damages. Glomerulonephritis is one common cause of chronic kidney disease (CKD) with the promotion of inflammatory renal damage containing fibrosis and sclerosis glomerular.

This study aimed to evaluate the TGF-β1 level in CKD patients and compare it with the healthy control group.

This cross-sectional case-control study was carried out on 212 subjects admitted to the Nghe An Friendship General Hospital in Vietnam from March 2018 to February 2020. The case group included 152 patients diagnosed with CKD caused by glomerulonephritis, and the control group included 60 healthy individuals. The TGF-β1 was determined in serum by ELISA method.

The serum TGF-β1 concentration of the healthy control group and CKD group was 13.45 ± 7.17 and 32.35 ± 11.74, respectively. The CKD group had a significantly higher TGF-β1 level than the control group (P < 0.05). The CKD group with the eGRP ≥ 60 mL/min/1.73 m2 group had a higher TGF-β1 level than the eGRP < 60 mL/min/1.73 m2 group, and the TGF-β1 level increased from stage 1 to stage 5 (P < 0.001). The TGF-β1 had a medium correlation to urea, creatinine, and hs-CRP.

The concentration of TGF-β1 in the CKD group was higher than the control group so that it increased early from the first stage of the disease.

Cardiovascular events are the leading global cause of death. Calcification of coronary arteries is a common complication of renal failure and the leading cause of death in this population. However, its multifactorial mechanism is not fully understood.

The current study aimed to, firstly, investigate the association between renal dysfunction and the calcification of coronary arteries in patients with severe and milder stages of renal failure and, secondly, to determine the role of this variable by eliminating the effect of established confounding factors.

Following a retrospective design, 261 patients with cardiovascular risk factors or atypical symptoms were investigated. Estimated GFR (glomerular filtration rate) was calculated using both Cockcroft-Gault and MDRD equations. An ECG-gated multidetector CT scan was performed to calculate CACS (coronary artery calcification score) using the Agatston method. The presence of significant CAC (coronary artery calcification) was defined as CACS > 100. Univariate and multivariate analyses were performed using binary logistic regression.

A total of 134 cases were diagnosed with CAC, and the mean CACS was 83.4 ± 18. According to univariate analysis, older age, male gender, systolic and diastolic blood pressure, and higher TG levels were correlated with the degree of CAC. HbA1C showed a weak correlation with CACS (P-value = 0.04). Renal insufficiency resulted in increased CAC, and lower eGFR (calculated with both Cockgraft-Gault and MDRD equations) was associated with higher calcification (P-value < 0.01). Our analysis shows that serum Ca, P, LDL, and HDL levels do not have a significant influence on calcification changes. After adjusting for confounding factors, male sex, age, triglyceride level, and eGFR were recognized as independent risk factors for CACS≥ 100, a marker of coronary artery atherosclerosis. However, HbA1C and systolic and diastolic blood pressure were no longer considered as factors that contribute to the risk of CAC.

We observed a gradual and independent association between lower eGFR and higher CAC scores.

Depression is one of the most common psychiatric problems in hemodialysis patients.

This study aimed to evaluate the effect of cool dialysate on depression in patients with chronic renal failure treated with hemodialysis.

This randomized clinical trial was performed on 66 hemodialysis patients suffering from depression. Patients were selected by a convenience sampling method and divided equally into intervention and control groups randomly by permuted block allocation, each group containing 33 patients. Data were acquired with the Beck Depression inventory-I. The intervention and control groups underwent one month of treatment with cool dialysate at 35.5 and 37°C, respectively. The severity of depression for each group was measured at the end of each treatment stage and two weeks after the intervention. Data were analyzed using R version 25 software with a confidence level of 95%.

There was no statistically significant difference between the control and intervention groups before and after the intervention (P-values more than 0.05). While the mean of depression severity for the control group decreased from 26.15 ± 1.46 to 22.24 ± 2.00 (P-values < 0.01), the mean of depression severity for the intervention group decreased from 25.56 ± 1.28 to 22.41 ± 1.65 by the intervention (P-value > 0.05).

The application of cool dialysate as a non-pharmacological method did not significantly reduce the severity of depression in patients undergoing hemodialysis. Therefore, it is advised to perform further studies that include more research units from different geographical locations, considering a longer intervening duration.

Antioxidant enzymes and selenium in semen plasma have vital effects on reducing lipid peroxidation of spermatozoid membrane in elderly organisms by preventing the destructive effects of reactive oxygen species. Therefore, the use of antioxidants and selenium is essential for normal testicular function and spermatogenesis.

In this experimental study, 44 male Wistar rats aged 2.5 months (young) and 44 male Winstar rats aged 11 months (old) were separated into 4 groups of control, placebo, experimental 1 (0.2 mg/kg BW), and experimental 2 (0.4 mg/kg BW). Rats encountered weekly surgery after a week of receiving different treatments. Resection of their testes was used for histological studies.

The number of spermatocytes, spermatid, and spermatozoa in young and old rats increased during the study period. In young rats, the highest number of these cells remarked in the third and fourth weeks of the experiment using selenium nanoparticles (ranged from 165.3 to 285.3 × 106 ). For old rates, the highest number of the abovementioned cells observed in the second week of the experiment (ranged from 143.3 to 146.7×106 ). Variables of treatment, week, and age presented significant effects on the number of testicular germ cells. Also, applied treatments had no significant effect on the sperm quality characteristics of rats. The number of Sertoli and Leydig cells did not show a significant difference compared to the control group. The results showed a positive and highly significant correlation between spermatozoid, spermatocytes, and spermatocytes. The findings also indicated the same genetic and environmental effects on the traits. Therefore, any spermatocyte shift will have a direct influence on the spermatozoid.

This study demonstrated that using selenium nanoparticles in young and old age groups in rats could improve testicular germ cells, especially in the old group. Therefore, with growing age and decreasing sperm quality, selenium nanoparticles can be used due to their positive effect on sperm parameters and their low health risk.

Urinary tract calculus formation can be prevented by identifying molecules and metabolic disturbances that affect this process. Osteoprotegerin (OPG), a cytokine of the TNF receptor superfamily, has been demonstrated to mediate vascular calcification and intimal calcification. Endothelial injury and oxidative stress are known to play a role in urolithiasis in the form of Randall’s plaques.

The present study aimed to compare 24-h urinary and serum OPG levels of patients with and without urolithiasis.

In this case-control study, 24-h urinary levels of OPG (pg/mL), serum levels of OPG (pg/mL), and creatinine (mg/dL) were measured in both groups. Urinary and serum levels of OPG were determined by enzyme-linked immunosorbent assay (ELISA) using human OPG kits.

Mean serum creatinine was 0.86 ± 0.21 mg/dL in the case group and 0.77± 0.16 mg/dL in controls. The difference in the mean serum OPG levels between the cases (227.13 ± 98.02 pg/mL) and controls (47.28 ± 29.61 pg/mL) was highly significant (P value < 0.0001). The difference in the mean 24-h urinary OPG levels between the cases (156.12 ± 174.31 pg/mL) and controls (9.32 ± 23.72 pg/mL) was highly significant (P value < 0.001).

There were significantly higher levels of OPG in serum and 24-h urine samples of cases than in controls. Hence, it requires further large studies to make OPG a diagnostic and prognostic marker.

Bladder cancer is the secondmost common urologicmalignancy. Transurethral resection (TUR) is the standard initial treatment for non-muscle-invasive bladder cancer (NMIBC). The high prevalence of residual tumor in some patients has necessitated repeat TUR (re-TUR). Previous studies have shown the quality of primary resection to impact re-TUR outcomes, but the role of tumor biology remains unclear.

This study aimed to evaluate the impact of tumor biology on re-TUR results in primary (non-recurrent) patients with superficial bladder tumors.

We studied a cohort of consecutive primary patients with superficial bladder cancer undergoing resection and routine re-TUR between March 2018 and February 2019 at our unit. Patients with TaG1 or T2 on primary pathologic report, deliberately incomplete initial resection, or absence of detrusor muscle on the initial specimen were excluded from the study. Re-TUR was performed in the sixth week. All procedures were performed by the same surgeon. The patients were divided into three groups according to the European Organization for Research and Treatment of Cancer (EORTC) risk scoring system and compared for recurrence of NMIBC.

Of 58 primary patients, 16 were classified as low-risk, 32 as intermediate-risk, and 10 as high-risk. The mean age of subjects was 62.1 years. Residual tumor was detected on re-TUR in 19 (32.7%) cases. Also, 3 (5.2%) cases entailed stage progression to pT2, all of whom belonged to the high-risk group. Residual tumor rate was 0%, 40.6%, and 60% in the low-, intermediate-, and high-risk groups, respectively. In addition, 13 patients had macroscopic residual.

Despite the modest study size, our results suggest that tumor biology might have an impact on residual tumor characteristics, and the EORTC scoring system may help to predict the risk of progression and residual tumor rate on re-TUR.

Although several regimens have been approved for the treatment of hepatitis C virus (HCV) infection, sofosbuvirbased regimens are not approved for the treatment of HCV infection in patients with severe renal impairment.

This study was conducted on hemodialysis patients infected with HCV. The patients received a constant dose of sofosbuvir/daclatasvir (SOF/DCV). Sustained virologic response (SVR) was evaluated 12 weeks after completion of treatment.

Fifty-one hemodialysis patients with HCV infection were selected and treated with a combination of SOF/DCV. Eleven patients expired during the anti-HCV treatment due to causes not related to liver disease or antiviral therapy. Finally, 40 patients finished the treatment, and 36 cases were evaluated for SVR. Among those tested for SVR, 35 (97.2%, 95% CI: 85.5 - 99.9%) achieved SVR and one (2.8%, 95% CI: 0.1 - 14.5%) relapsed. No patient reported severe adverse events.

The combination of SOF/DCV showed great efficacy and safety in hemodialysis patients with severe renal impairment and chronic HCV infection.

The choice of treatment for benign prostatic hyperplasia (BPH) and kidney stone disease (KSD) impacts the attainment of successful ageing and the level of patient care required in the long-term. Medications and surgeries typically used for these conditions have serious side effects and can interfere with healthy aging.

This study assesses the impact of Dr Allen’s Therapeutic devices (DATD) and thermobalancing therapy® (TT) on the ageing process of people with BPH and KSD.

This study evaluated the outcomes of a clinical trial investigating the dynamics of symptoms and parameters in 124 male patients with BPH who used DATD as a monotherapy for six months at home and compared the results with a control group comprising 124 BPH patients who did not receive treatment with DATD. Furthermore, five case studies were randomly selected for assessment from 10-year empirical observations of patients with KSD treated with DATD.

DATD with TT reduced prostate volume (PV) from 45 mL to 31 mL (P < 0.001) and reduced urinary symptoms score from 14.2 to 4.9 (P < 0.001). It also improved quality of life (QoL) as measured by the reduction in the International Prostate Symptom score (I-PSS) from 3.9 to 1.3 (P < 0.001), while the control group showed no positive changes. DATD with TT dissolved kidney stones without renal colic in all patients. No side effects were observed.

Using DATD and TT to treat BPH and KSD demonstrated high efficacy, safety, and easy disease management at home. In contrast, medications and surgeries for BPH and KSD often lead to sexual dysfunction, depression, hypertension, chronic kidney failure, and other morbidities, requiring an increased care level in the long-term. Thus, DATD and TT generate high treatment efficacy with lower exposure to coronavirus, reduce long-term care needs, and are vital to attaining successful ageing and longevity.

Bilateral huge perirenal Angiomyolipoma is a very rare entity and has not been reported in the literature to date. The choice of appropriate management for such a rare disease may be a dilemma because each strategy can harbor its own advantages and hazards.

We present our experience with such a patient over seven years of follow-up. Performing surgery in this patient might have ended up in unilateral or bilateral kidney loss, and he refused the surgery and underwent watchful waiting.

Like conservative management that was successful for more than seven years. In this case, other treatment options such as angioembolization and surgical resection are vital options with their own risks and benefits.

Quality of life (QoL) is one of the essential measures in assessing a patient’s status after kidney transplant, and emotional response is an important factor in evaluating the patient’s compatibility with the transplant. Also, emotional response affects a patient’s QoL.

This study aimed to compare the QoL and emotional responses of kidney recipients from deceased and living donors.

This descriptive comparative study randomly selected 118 kidney transplant patients (67 recipients from living donors and 51 recipients from deceased) referred to the Nephrology Clinic of Tehran University of Medical Sciences for a post-surgery follow-up. The QoL questionnaire for patients with renal transplants introduced by Laupacis et al. and the emotional response questionnaire (ERQ) by Ziegelmann et al. were used in this study. For data analysis, Mann-Whitney, independent t-test, and Pearson’s correlation tests were used. All the analyses were performed using SPSS software version 20.

The kidney recipients from living donors had significantly higher QoL score (especially emotionally) compared with kidney recipients from deceased donors (P=0.04). The score of emotional response was higher in recipients from a living donor, which is related to feeling guilty, transplant disclosure. Furthermore, recipients from a living donor felt guiltier and were unwilling to disclose their transplant compared with recipients from deceased donors.

Feeling of guilt and being anxious about transplant disclosure were higher in recipients from living donors. A significant difference was observed in the QoL and emotional response between the two groups of kidney recipients. Therefore, it is important to involve the transplant team, specifically nurses, in the identification of emotional response and planning accordingly to improve the patients’ QoL, especially in recipients from a living donor.