Iranian Journal of Kidney Diseases
Volume:15 Issue: 6, Nov 2021

Coronavirus disease 2019 (COVID-19) is a catastrophic contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Electrolyte disturbances are common complications of COVID-19. The present article examined the potential mechanisms of hypokalemia and hyperkalemia in patients suffering from COVID-19, in order to raise awareness of potassium disorders in SARS-CoV-2 infections. PubMed, Scopus, and Google Scholar were searched with keywords, such as “COVID-19”, “SARS-CoV-2”, “2019-nCoV”, “Hypokalemia”, “Hyperkalemia”, “Serum potassium”, and “Etiology”, “Pathophysiology” up to April 20, 2021 without any search filters. We included articles that proposed potential mechanisms for potassium abnormalities in COVID-19 patients. Furthermore, we used backward and forward citation searching. Potassium abnormalities are considered to be important electrolyte disturbances, with reported incidences ranging from < 5% to > 50% in patients affected by SARS-CoV-2. Therefore, understanding the etiologies of potassium abnormalities could help to improve disease outcome. Utilization of ACE2 by SARS-CoV-2 in the renal cells, viral-induced tubular injury, and gastrointestinal abnormalities, such as anorexia, diarrhea, and vomiting may predispose COVID-19 patients to developing hypokalemia. Furthermore, depleted magnesium levels make hypokalemia refractory to treatments. In addition, hyperkalemia may occur because of reduced urinary output, as a consequence of renal failure. Changes in blood pH and medication-induced side-effects are other possible reasons for the deviation of potassium levels from the normal range. The etiology of potassium abnormalities in COVID-19 patients is multifactorial. Therefore, the early detection and management of potassium disorders is vital and would improve the outcome of patients with COVID-19.

Focal segmental glomerulosclerosis (FSGS) is one of the important causes of end stage kidney disease (ESKD). We evaluated the progression risk factors of primary FSGS to chronic kidney disease (CKD) or ESKD with a predictive model including clinical and histological predictors.

201 patients with primary FSGS (59% male, mean age: 38 ± 15 years), were studied. Time-dependent Cox model and C statistics were used for the predictive model. Interaction and correlation between independent variables were estimated.

During 55 ± 27 months of follow-up, 82 patients (41%) developed CKD (46) or ESKD (36) patients. In adjusted model, 1 unit of higher serum creatinine (SCr) at baseline (HR = 1.39, 95% CI: 1.15 to 1.70) and 1% increase in glomeruli with segmental glomerulosclerosis (SGS) (HR = 1.03, 95% CI: 1.02 to 1.04) or interstitial fibrosis/tubular atrophy (IF/TA) (HR = 1.03, 95% CI: 1.01 to 1.05) increased the risk of CKD/ESKD. In adjusted model, higher baseline proteinuria and collapsing variant were not associated with risk of CKD/ESKD. By adding SGS and IF/TA scores to baseline SCr in the model, discrimination by C statistics was 0.83 (95% CI: 0.77 to 0.90). Median renal survival was 3.1 years (95% CI: 2.2 to 4.1 years) in patients with highest risk score (baseline eGFR < 25 mL/min/1.73m2 + IF/TA/SGS > 50%), and 8.1 years (95% CI: 7.7 to 8.6 years).in those with lowest score (baseline eGFR > 75 mL/ min/1.73m2 + IF/TA/SGS < 5%).

In primary FSGS, higher baseline SCr, increased SGS and IF/TA, but not baseline proteinuria and collapsing pathology, were the predictors for CKD/ESKD. These findings indicated the importance of timely detection and referral in prognosis of primary FSGS.

Anti-Compliment Factor H antibody hemolytic uremic syndrome (AFH-HUS) is a common cause of paediatric atypical HUS in India. We wanted to study the outcome of patients receiving less than recommended plasma exchange (PLEX) but adequate immunosuppression, with respect to hypertension, preservation of renal function and proteinuria.

A retrospective study was performed in 15 children admitted from 2016 to 2018 with AFH-HUS. Follow up details including physical examination, hematological parameters, renal function test and urine examination performed at 3, 6, and 12 months were noted. Risk stratification and staging for chronic kidney disease (CKD) were done according to the Kidney Disease Improving Global Outcomes (KDOQI) guidelines. Standard statistical tests which were appropriate were used.

Mean age of our study cohort was 7.8 ± 1.9 years. 14 children had hypertension. Mean nadir hemoglobin was 5.8 ± 1.0 g/dL and platelet = 58 ± 37.7 × 109 cells/L. Median anti factor H (AFH) level was 316 AU/mL (150 to 452). Hemodialysis was required in 7 children. Fourteen children received PLEX with a mean of 11 ± 6 cycles. Thirteen children received 6 cycles of intravenous cyclophosphamide. After six months, therapy was switched to mycophenolate mofetil in 4 children, steroids alone in 2 children and 9 children with azathioprine. On follow-up, risk of CKD reduced from 80% at 3 months to 26% at 12 months (P = .01). Only 40% patients had CKD stage 2 at the end of 12 months (mean eGFR = 95.0 ± 19.4 mL/min/1.73m2).

The adequate number of PLEX needed in AFH-HUS needs further studies. Till such reports come, PLEX in recommended strategies or lesser, if not available, with immunosuppression in AFH-HUS can decrease progression to CKD.

Fibroblast growth factor-23 (FGF23) is responsible for regulating the metabolism of phosphorus and vitamin D by affecting the kidneys and parathyroid gland. Phosphate is present in the 2, 3-diphosphoglycerate (2,3DPG) ester composition, which can shift the O2-Hb dissociation curve to the right. Therefore, we hypothesized that maybe there is an association between red cell distribution width (RDW) and FGF23 level. The aim of this study was to investigate the relationship between iFGF23 and RDW in patients with end-stage renal disease undergoing hemodialysis.

This cross-sectional study was performed on 254 endstage renal diseases (ESRD) patients undergoing hemodialysis who were admitted to Rasht Razi Hospital Hemodialysis Center, in 2017. We used Shapiro-Wilk, Spearman correlation coefficient, Mann– Whitney U-test, and Multiple Linear Regression Analysis. All statistical analyses were performed by SPSS software.

The median age of patients was 60 years (IQR: 49 to 69). The mean and median iFGF23 concentration in patients were 59.5 ± 14.6 and 62 (IQR: 49 to 69) pg/mL, respectively. According to spearman test, iFGF23 had a statistically significant association with age (r = 0.856, P < 0.001), MCV (r = 0.202, P < .001), phosphorus (r = -0.176, P < .05), weight difference before and after dialysis (r = -0.264, P < .05), and Vitamin D (r = -0.201, P < .05). Also in multiple linear regression analysis, the variables of RDW, IDWG, iPTH, MCH, DM, HTN, Age, and CRP were considered as predictors of iFGF23 .

RDW was identified as one of the predictors of iFGF23 changes. Perhaps in the future, more value will be given to the role of RDW in dialysis patients.

Kidney transplantation is the treatment of choice in the majority of end-stage renal disease (ESRD) patients. However, most of the incident ESRD patients are not given the necessary information regarding kidney transplantation. The aim of this study was to evaluate awareness and knowledge about kidney transplantation in ESRD patients who were on dialysis.

In this cross-sectional study, a total of 300 ESRD patients who underwent hemodialysis or peritoneal dialysis and could be eligible for kidney transplant, were included. A questionnaire with 15 multiple choice questions (MCQs) was designed to collect the data. SPSS version 16 was used for data analysis and a P value less than .05 was considered statistically significant.

Two hundred thirty- four patients participated in the study (response rate of 78%). Among them 58.1% were male with the mean age (SD) of 52.5 (12.1) years. The majority of the patients (94.0%) were on hemodialysis. About 87.6% wanted to receive kidney transplant; but despite the desire of the patients, this method was initially offered to about 11.5 % of the patients as a possible method of renal replacement therapy. Patients who had desire to receive kidney transplantation were significantly younger, male, married, employed, and had high level of education (P < .05).

Although most of the patients wanted to receive a kidney transplant, it was initially offered to a small population. Age, gender, marital status, employment condition, and level of education were significant factors for the patient’s tendency to receive a kidney transplant.

Cardiovascular disease is considered as the main cause of mortality and morbidity in HD-patients and AS is a fundamental cause. This study was conducted to investigate whether intradialytic BP changes can use as a surrogate clinical marker.

Fifty-one patients on maintenance hemodialysis, for at least 12 hours per week, were included in a prospective cohort study. Intradialytic BP was measured using validated automated device. PWV was performed to assess Augmentation Index (AIx) as marker of arterial stiffness. All measurements were repeated in alive individuals after 5 years of follow-up. Patients with 5% reduction of intradialytic BP were considered as HD-responsive and Several statistical analyses were employed based on responsiveness to HD.

After 5-year follow-up the findings demonstrated BP response to HD was an important and independent determinant of mortality (P < .05). Augmentation index (AIx) (P < .05), heart rate (P < .05), and calcium phosphate product (P < .05) as well as log PTH (P < .05) were significantly different between two responsive and non-responsive to HD. Pearson’s Correlation studies revealed a significant relationship between the BP response to HD and heart rate (r = 0.4, P < .05), LVEF (r = -0.4, P < .05) and PTH (r = -0.3, P < .05). BP response to HD and log-PTH remained significant even after age and gender adjustment (P < .05).

BP-response to HD can use as a clinical and surrogate marker of AS which is significantly associated with mortality and LVEF. Arterial stiffness and intradialytic BP can predict the changes in Ejection Fraction (EF).

Both teriparatide and alendronate were used in the treatment of osteoporosis after renal transplantation. However, there are few studies comparing their application after renal transplant surgeries. This study was carried out to compare the effect of alendronate and teriparatide on bone mineral density in the treatment of osteoporosis after renal transplantation.

This is a retrospective cohort study of 153 patients who were diagnosed with osteoporosis after receiving renal transplantation, and received either alendronate or teriparatide treatment. The demographic patient information, changes in patients’ quality of life, mobility and pain scores, serum biochemical markers and bone density of lumbar spine, hip and femoral neck were measured and compared between groups a year after treatment.

there were no significant differences between the two groups concerning patient demographics such as age, gender and BMI. After a year of treatment, there were no significant differences between the two groups in biochemical markers such as serum calcium, phosphorus, creatinine and 25-OH Vitamin D (P > .05). BMD of lumbar spine, hip and femoral neck after the treatment was significantly higher in the teriparatide group than alendronate group (P < .05), while the incidence of adverse effects was higher in the teriparatide group than alendronate group (P < .05).

teriparatide can be more effective than the alendronate in the treatment of osteoporosis in renal transplant patients, while having more adverse effects

Monoclonal immunoglobulin deposition disease (MIDD) is a rare disease characterized by the non-fibrous deposition of monoclonal immunoglobulin molecules along the glomerular or tubular basement membrane in kidney. We report herein the details of one case of heavy chain deposition disease (HCDD) diagnosed by renal biopsy, a relatively rare subtype of MIDD.