Iranian Journal of Kidney Diseases
Volume:15 Issue: 5, Sep 2021

A growing body of evidence points out at chronic kidney disease (CKD) as a major risk factor for severe COVID-19, increasing also the respective mortality risk. Preventive measures, rapid monitoring organ function and interventions capable of preventing multiorgan failures are of great importance to reduce adverse outcomes in COVID-19 patients with CKD. While efforts are underway to carry out indirect protection interventions and large-scale vaccination to achieve herd immunity in the general population, direct protection of patients with CKD through rapid vaccination trials are necessary since uraemia and immunosuppressive agents could have a negative impact on vaccination responses of CDK patients. More epidemiological data are needed for in-depth understanding of the course and outcome of COVID-19 in CKD patients, supporting clinical decision-making.

Vesicoureteral reflux (VUR) is a well-known risk factor for urinary tract infection (UTI). We aim to define diagnostic values of kidney ultrasonography (US) as a predictor of VUR and high grades VUR in children presented by UTI.

This retrospective study was conducted during October 2003 to 2016. Children aged ≤ 18 years with history of UTI who had underwent kidney US and direct cystography [voiding cystourethrography (VCUG) or radionuclide cystography (RNC)] enrolled in the study. Diagnostic values of hydronephrosis, hydro ureter, renal scaring, hydroureteronephrosis, decreased kidney size and abnormal kidney US for diagnosis of VUR and high grades VUR (grades IV-V) were evaluated.

Hydro-ureter, renal scaring, and hydroureteronephrosis were significantly more prevalent in VUR+ versus VUR- cases, also in higher grades compared with lower grades (grades I-III) VUR (P < .05 for all). Additionally, hydronephrosis was more common in VUR+ compared with VUR- patients (P < .0001). As a predictor of VUR and higher grades of VUR, abnormal kidney US had the highest sensitivity (24.87% and 40.84%, respectively), abnormal kidney US and hydro ureter reached the highest NPV (70.42% and 81.27%, respectively), hydroureteronephrosis and hydro ureter showed the highest accuracy (68.51% and 82.21%, respectively) .

Kidney US is a valuable screening test, abnormal renal US significantly increases the probability of VUR and high grades VUR , but if used as the only screening test , about 2/3 and 1/3 and 20% of VUR , high grades VUR and grade V VURs will be missed.

Previous studies have investigated the applicability of different serum biomarkers for the diagnosis of urinary tract infection (UTI) and differentiation between acute pyelonephritis (APN) and cystitis. We aimed to compare serum D-dimer with procalcitonin (PCT) for the diagnosis of UTI and prediction of APN in a pediatric population.

This cross-sectional study included children aged 1 month to 14 years with their first UTI episode confirmed by positive urine culture. Serum PCT and D-dimer were measured in all participants before the initiation of antibiotic therapy. Dimercaptosuccinic acid (DMSA) scan was performed in all children within 2 months of UTI resolution to determine renal parenchymal involvement.

From the 43 children included in this study, 69.8% were female. D-dimer level was significantly higher in boys (823.26 ± 298.19 vs. 582.96 ± 359.96 ng/mL; P < .05). PCT level was comparable in boys and girls (P > .05). Logistic regression revealed that regardless of gender, children aged 2 to 6 years had significantly higher chance of at least one positive marker compared to those 6 to 14 years (OR = 6.12, 95% CI: 1.09 to 34.47, P < .05). The area under the curve value from the receiver operating characteristic curve of D-dimer ≥ 513 ng/mL for prediction of APN was 0.873, with a sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 84.8, 90, 96.6, 64.3, and 86%; respectively.

According to the results of the current study, 81.4% of children aged 1 month to 14 years with their first UTI episode, were either PCT or D-dimer positive. D-dimer appears to have the highest diagnostic performance for the detection of APN.

Previous studies have suggested that linagliptin may represent renoprotective effects besides its anti-hyperglycemic properties in patients with type 2 diabetes. However, there is a lack of decisive evidence to support this assumption. This study aimed to address the effect of linagliptin in type 2 diabetic patients with severely increased albuminuria.

In this randomized double-blind, placebo-controlled clinical trial, type 2 diabetic patients with severely increased albuminuria (albuminuria ≥ 300 mg/24 h) were enrolled. Patients were randomized to linagliptin (5 mg/d) and placebo based on a computer-generated list of random numbers. Biochemical (fasting blood sugar (FBS) (mg/dL), hemoglobin A1c (HbA1c) (%), proteinuria (mg/24h), blood urea nitrogen (BUN) (mg/dL), serum creatinine (mg/dL)) and clinical variables (weight (kg), systolic, and diastolic blood pressure (mmHg)) were measured at baseline and 3 and 6 months post intervention.

At baseline, no statistically significant difference was detected in demographic characteristics between the two groups (P > .05). A significant decrease was observed in proteinuria, FBS, weight, SBP, and DBP in the intervention group after 6 months (Ptime < .05), however; none of the clinical and biochemical variables showed a significant difference between groups after 6 months (Pgroup > .05).

Linagliptin may serve as a renoprotective therapeutic option in diabetic patients with severely increased albuminuria due to its role in proteinuria reduction. Results of this study can be used for future large-scale, long-term studies investigating the renoprotective effects of linagliptin in patients with diabetic nephropathy.

Circadian system is deeply involved in renal function. The circadian timing system may be disrupted in chronic kidney disease (CKD) patients. Gender differences in CKD have been reported. This research aimed to investigate the gender differences in the circadian rhythm of inflammatory and oxidant markers of CKD.

Male, intact female, and ovariectomized (OVX) female rats (twenty-four in each group) were randomly assigned to control and CKD groups. The rats were further divided into day (12:00 p.m.) and night (12:00 a.m.) subgroups. Evaluations of each sample were carried out a day after the last day of adenine administration.

Final results revealed that the circadian rhythm of plasma melatonin , kidney malondialdehyde (MDA), and transforming growth factor- β (TGF-β) levels in CKD group were the same as the control group. Melatonin and total antioxidant capacity (TAC) levels significantly decreased in the CKD group compared with the control group in day and night subgroups, whereas MDA and TGF-β levels increased. Male group in comparison with the intact female group significantly showed less melatonin and TAC but higher MDA and TGF-β levels which could be due to CKD.

Findings of this study represent gender differences in circadian rhythm amplitude of inflammation, melatonin, and oxidative stress in CKD animals, probably in favor of female sex steroids. These findings emphasize on the importance of gender differences in CKD progression; therefore, considerable attention must be paid to gender in the treatment of CKD.

Nephrologists usually encounter therapeutic challenges and dilemmas when treating steroid-dependent nephrotic syndrome (SDNS) and frequently relapsing nephrotic syndrome (FRNS). Due to the serious side effects of long-term administration of corticosteroids, physicians administer steroid adjuvants to maintain remission and to limit the cumulative dosage of corticosteroids. Among these adjuvants, it is postulated that mycophenolate mofetil (MMF) is an impressive option owing to its fewer side effects, acceptable tolerance, and high effectiveness.

This comparative study was performed on a group of SD/FRNS patients who were on MMF therapy for an average duration of 2.75 years and on regular follow-up at the Department of Nephrology of Imam Reza Hospital, Kermanshah, Iran.

A total of 32 patients with a male to female ratio of 1.2:1 were enrolled. The mean duration of follow-up prior to and following the initiation of MMF therapy was 2.63 and 2.75 years, respectively. The results obtained from the comparative analysis of the recurrence rate and the dose of corticosteroids used prior to and following the initiation of MMF therapy revealed that this therapy significantly lowered the recurrence rate (P < .05) and the corticosteroid dose (P < .05). Hence MMF is a well-tolerated and effective agent in decreasing the recurrence rate (64.52%) and the cumulative dosage of corticosteroid (43.88%) in complicated nephrotic syndrome patients.

There were no significant differences between the patients treated with MMF as the first steroid-sparing agent and those treated with MMF as the second or third agents.

Despite significant improvement in End Stage Kidney Disease (ESKD) patient’s management, and better availability of dialysis for caregivers, mortality among these patients is unacceptably high.

We collected the data of 751 incident hemodialysis patients from March 2004 to November 2018. Survival curves was created by using the Kaplan-Meier method. Comorbidities, as well as time-dependent values of laboratory findings, were examined as independent factors by three models of Cox regression analysis.

The median follow-up period was 31.7 months (1.08 to 169.28). Patient survival rates were 88%, 77%, 56%, 32%, 26% ,16% and 12%, at 1, 2, 4,6, 8, 10, 12 and 14 years of follow-up, respectively. The most common cause of mortality was cardiovascular disease. We observed lower survival rates in patients ≥ 65 years (HR = 2.684, 95% CI: 1.133 to 3.377; P < .001), diabetes mellitus (HR = 1.729, 95% CI: 1.484 to 2.014; P < .001) and walking disability (HR = 2.505; 95% CI: 2.104 to 2.983; P < .001). Low hemoglobin level (HR = 1.496; 95% CI: 1.257 to 1.779; P < .001), hyperphosphatemia (HR = 1.305, 95% CI: 1.104 to 1.542; P = 0.002) and high low-density lipoprotein cholesterol level (HR = 1.933; 95% CI: 1.431 to 2.611; P < .001) were predictors of mortality. A single pool Kt/V > 1.2 (HR = 0.743, 95% CI: 0.635 to 0.870; P < .001) and high serum creatinine level (HR = 0.842, 95% CI: 0.811 to 0.874; P < .001) showed protective effects.

Our study showed a high survival rate in a single center cohort of hemodialysis patients in Iran. Traditional risk factors of mortality in general population, as well as indices of dialysis efficacy and general health status were the main predictors of mortality. Nationwide registries are necessary to investigate the dialysis survival rates and their predictors in our country.

This study hypothesized that the insulin Degludec may have benefit if used in management of diabetes mellitus after renal transplantation to achieve better control at the critical time of adjustment of immunosuppressive regimens during the first year post transplant.

Fifty patients with Type 2 diabetes Mellitus after renal transplantation with stable serum creatinine with glycosylated hemoglobin (HbA1C) 7 to 11% were included in the study to receive either Insulin Degludec or Insulin Glargine. Fasting blood glucose, 2 hour post-prandial levels and (HbA1c), were measured at 12, 16, 26, 40, and 52 weeks after renal transplantation also hypoglycemic episodes were documented all through the study.

Despite both groups are matched as regards demographic and metabolic data, FPG, and 2h PPG were lower in insulin Degludec group all through the study. HbA1c most pronounced decline, occurred at 52th week of treatment in both groups. The most important clinically relevant finding in our study was that; the overall confirmed hypoglycemia rates and the rate of nocturnal confirmed hypoglycemia was significantly lower with Degludec treated group (P < .001).

Insulin Degludec provides optimum glycemic control in in the first year post-renal transplant patients with significantly lower rate of hypoglycemia.

Small vessel necrotizing vasculitis is divided into two groups; Immune complex mediated and Pauci immune vasculitis. Hemolytic uremic syndrome (HUS) is a rare disease manifested as microangiopathic hemolytic anemia, thrombocytopenia and renal involvement. The coexistence of ANCA negative vasculitis and atypical HUS (aHUS) is rare. We describe a case of a 40 years old lady with rapidly declining kidney function. Renal Biopsy revealed Crescentic necrotizing glomerulonephritis (CGN). She was treated with plasmapheresis alternating with hemodialysis (HD) and immunosuppressive therapy. One month later she developed hemolytic anemia with peripheral schistocytes and thrombocytopenia and diagnosed as aHUS. Same treatment continued and her aHUS resolved spontaneously over one week. However her kidney functions didn’t improve and ended up with end stage renal disease (ESRD).