Journal of nephropathology
Volume:11 Issue: 1, Jan 2022

Autophagy is a way to create new cellular structures, clear cells invaded by microbes, and block accumulating proteins that can cause disease. Moreover, it can destroy all cellular organs and pathogens, including fungi, parasites, bacteria, and viruses, either randomly or selectively. Many research groups are examining a strategy to combat COVID-19. In particular, research is underway to identify drugs that can target autophagy in COVID-19 virus infection. Several known drugs are currently under clinical evaluation for the autophagy process, given that regulating autophagy is a way to combat COVID-19. This study introduces drugs that target the autophagy pathway.

 Aleebrahim-Dehkordi E, Saberianpour S, Soleiman-Dehkordi E, Hooshyar D, Mojtahedi Z, Kianpour N, Hasanpour-Dehkordi A, Saberian L, Akhavan Sepahi M. Autophagy and treatment of patients with COVID-19; which drugs target the autophagy pathway? J Nephropathol. 2022;11(1):e01. DOI: 10.34172/jnp.2022.01.

One of the causes of end-stage renal disease (ESRD) in some countries is the renal involvement caused by the complications of the familial Mediterranean fever (FMF). Amyloidosis is of the most important complications of FMF that can lead to ESRD. We report our experiences of FMF patients with ESRD who received hemodialysis and kidney transplantation over the past 17 years. Of nine patients, four had amyloidosis, two had focal segmental glomerulosclerosis (FSGS), one had IgA nephropathy, and two did not undergo biopsy because their kidneys were atrophic. Of the nine patients, one died of amyloidosis. Seven patients had kidney transplantation and one patient is currently undergoing dialysis. Six patients were transplanted from a living donor and one from a cadaver. The ultrasound examination revealed that five patients had bilateral kidney atrophy, four patients had normal size kidney with amyloidosis. None of the seven patients who underwent renal transplantation had a history of rejection. Kidney transplantation and hemodialysis in patients with FMF is similar to those with other ESRD etiologies.

 Bladder stones represent 5% of urologic stones. We report a-45-year old woman referred to our office with occasional supra-pubic pain for three months. Ultrasound of abdomen and pelvic showed a 20 mm stone in bladder. Abdominopelvic CT with intravenous contrast revealed no genitourinary abnormality. In cystoscopy, we detected a mucosal bulging on the left lateral wall of the bladder. Its mucosa was intact. Then we incised on the mucosa with cautery and extracted the stone. Sub-mucosal bladder stone could be developed in even normal women without any background illnesses.

Zahirian Moghadam T, Mohseni Rad H, Hossein Khani A. A case report of sub-mucosal bladder stone. J Nephropathol. 2022;11(1):e03. DOI: 10.34172/jnp.2022.03.

Renal biopsy is an important diagnostic procedure in pediatric nephrology. Although considered as an invasive method, numerous renal diseases cannot be definitively diagnosed and treated without it.

The aim of this study was histopathological study of renal biopsy results in children of 6 months to 18 years old.

In this retrospective cross-sectional study, the available data from children who had undergone kidney biopsy between 2007 and the end of 2017 were evaluated. Demographic data, indications of biopsy, the outcome of patients, biopsy complications and histopathologic findings were collected using a checklist. Finally, data were presented as frequency and percentages.

The most common cause of biopsy in children was nephrotic syndrome (43.7%). Focal segmental glomerulosclerosis (FSGS) with 39 cases (32.7%) had the highest frequency in examined biopsies. In the long-term follow-up, 71 children (59.7%) cured, 7 (5.9%) died, 25 (21.0%) continued treatment, 6 (5.0%) underwent a kidney transplant surgery, and the outcome of 10 children (8.8%) was unknown. While 6.7% of patients were diagnosed with complications of biopsy, the most frequent of them was hematuria. There was no case of death or nephrectomy and only one patient needed packed RBC transfusion.

Nephrotic syndrome was the most common indication for kidney biopsy. FSGS had the highest frequency in examined biopsies

Acute renal failure is a well-known complication in patients after cardiac surgery.

The determination of disease-causing factors with the aim of identifying patients at high- risk and implementing preventive care pre- and postoperatively to reduce the incidence of acute kidney injury (AKI) in patients after cardiac surgery.

The present cross-sectional research was carried out on 512 adult patients who underwent cardiac surgery between 2015 and 2016 in our tertiary center. Demographic and laboratory data of patients were obtained using a checklist. AKI is defined as an increase of at least 0.3 mg/dL in creatinine (Cr) over 48 hours and one week after surgery according to acute kidney injury network (AKIN) and RIFLE (risk, injury, failure, loss of kidney function, and end-stage renal failure) criteria before surgery. All data were analyzed by SPSS version 1, and P value <0.05 was considered significant.

In this study we found, AKI risk profiles including serum Cr level [OR = 3.24, 95% CI = 1.92 -12.48, P = 0.001], fasting blood glucose [OR = 1.22, 95% CI = 1.09 -1.92, P = 0.03] and hemoglobin (Hb) before surgery (OR = 0.59, 95% CI = 0.08 -0.87, P = 0.04) were significantly associated with increased risk of acute renal injury (logistic regression analysis).

The results indicated that changes in serum Cr level, fasting blood glucose and plasma Hb before cardiac surgery might be considered as the risk factors for AKI after cardiac surgery.

Various studies considered albuminuria as one of the first asymptomatic paraclinical manifestation of the micro-vascular damages in type 2 diabetes mellitus (DM). Hypertension (HTN) is common in type 2 DM, which has a correlation with the greater risks of cardiovascular morbidity and death.

The present research evaluated the relationship between blood pressure (BP) variability in diabetic patients who have or not albuminuria.

In this analytical-descriptive research, we divided 90 type 2 diabetic patients into two groups of micro-albuminuric (urinary albumin excretion ≥30 mg/d and <300 mg/d) and the normo-albuminuric (urinary albumin excretion <30 mg/d) diabetic patients. We evaluated systolic and diastolic BP and 24-hour Holter monitor BP and heart rate, with respect to their albuminuric states and glomerular filtration rate (GFR) stages.

According to the findings, a considerably greater BMI (body mass index) and retinopathy was observed in microalbuminuric group in comparison with the normoalbuminuric group (P<0.05). Additionally, non-dipping pattern was greater in the microalbuminuric patients (P<0.05). In addition, patients were divided into dippers and non-dippers, the mean daytime and nighttime BP and heart rate were compared. Mean arterial BP (MAP) and nighttime BP and substantially in the subgroup of patients with GFR below 60 mL/min, systolic blood pressure (SBP) were considerably greater in the micro-albuminuric patients (P<0.05).

In patients with diabetes, the existence of albuminuria is related to the increase in the incidence of non-dipping pattern compared with patients without albuminuria. According to high levels of SBP in albuminuric patients with low GFR, the pattern of HTN and then albuminuria and the subsequent reduction of renal function can be similar to that of type 1 DM patients. Moreover, 24-hour Holter monitoring and BP should be monitored closely in diabetic patients

Hemodialysis (HD) patients are at increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

The aim of this study was to evaluate the prevalence and clinical symptoms of SARS- CoV-2 infection in HD patients.

This is a single-center study conducted at HD center, in Ilam, Iran. The study was included 87 HD patients to be tested. SARS-CoV-2 infection was diagnosed with confirmed test by rRT-PCR (real-time reverse transcription polymerase chain reaction) assay.

Around 35.63% of HD patients were diagnosed as COVID-19 infection; most of them were male (74.4%). Dyspnea (58.1%) and cough (45.2%) were the most common symptoms among HD cases with SARS-CoV-2 infection. Diabetes (16.1%) and hypertension (19.4%) were the most coexisting medical illnesses. About 12.9% of patients needed ICU care. Additionally, 16.1% of our patients died, which all of them were male.

This study showed a high prevalence of COVID-19 among our HD group, accompanied by mild symptoms. The HD population is probably among the most sensitive and high-risk groups for COVID-19 because of advanced age, comorbidities disease, low-immune function and frequent required visits, and patient overload in HD centers. Preventive measures should be taken in order to minimize the virus transmission in dialysis centers.

Urinary incontinence is one of the causes of the dependence of the elderly on others and is one of the main reasons for sending the elderly to care centers.

The aim of this study was to determine the effect of behavioral interventions program on urinary incontinence in the elderly.

In this quasi-experimental clinical trial (without a control group), 30 elderly men with acute urinary incontinence were selected from elderly care centers in Urmia city using the available sampling method. The intervention included pelvic f loor and bladder exercises and lifestyle modification training, individually. The standard ICIQ-SF questionnaire was completed before and after the intervention. The data were analyzed by paired t-test and Wilcoxon tests.

The findings showed a statistically significant difference between urinary leakage frequency (P = 0.002), urinary leakage rate (P = 0.001) and the effect of urinary leakage on the quality of life (P < 0.001) of the subjects before and after the intervention.

The results of this study showed that a combination of the pelvic f loor and bladder exercises and lifestyle change are effective in decreasing urinary incontinence in elderly men. Trial Registration: The trial protocol was registered in the Iranian Registry of Clinical Trials (identifier: IRCT20180808040742N2; https://en.irct.ir/trial/43204, ethical code #IR.UMSU.REC.1391.31).

Patients with kidney transplants are at greater risk of contracting COVID-19 because of long-term immunosuppression and may end up with severe disease with adverse outcome. The experiences of COVID-19 management in kidney transplant recipients are limited. This is a case of COVID-19 in a 45-year-old patient with a second renal transplant on triple immunosuppressive therapy who was successfully treated for COVID-19, septic shock, acute kidney injury and was discharged with a stable graft function. The patient presented with mild COVID-19 symptoms but later went into septic shock followed by acute kidney injury due to a secondary bacterial infection. The patient was successfully managed using antivirals, corticosteroids, reducing the dose of immunosuppressants initially, then discontinuing all the immunosuppressants in view of septic shock and finally reinstating the immunosuppression gradually on clinical improvement. This case report may serve as a reference for treating immunocompromised kidney transplant recipients having COVID-19. However, more data and experiences are needed for optimization of treatment of kidney transplant recipients with COVID-19.

A 14-year-old boy with a past medical history of bone marrow transplantation (BMT) was referred to the emergency department with the loss of consciousness and seizure. On admission, the blood test indicated strict hyponatremia with hypokalemia, hypomagnesemia, hypophosphatemia, hypoglycemia, and low-serum low-density lipoprotein cholesterol (LDL-C). After six days, the patient suffered from dysarthria, dysphagia, behavioral disturbances, disorientation, and obtundation. Based on the physical examination, hyperreflexia and upward bilateral plantar reflexes were outstanding. Lumbar puncture, spiral brain CT scan, and MRI were normal. Hence, MRI repeated 2 weeks later, and the T2-weighted image indicated the bilateral symmetric hyperintense lesions in the basal ganglia. The osmotic demyelination syndrome (ODS) is a scarce and serious neurologic complication of the quick correction of chronic strict hyponatremia.

Choice of maintenance immunosuppressive therapy after renal transplantation is important for graft survival. However, complication may also occur. Venous thromboembolic event with the mTOR inhibitor (mTORi) everolimus is a rare but life-threatening complication. Here we describe a renal transplant recipient who developed pulmonary thromboembolism.