Iranian Journal of Kidney Diseases
Volume:16 Issue: 5, Sep 2022

It remains controversial, whether vitamin D reduces urinary albumin excretion in patients with diabetic nephropathy (DN). This metaanalysis was designed to evaluate the therapeutic effect of vitamin D, on urinary albumin excretion, in DN patients. Electronic databases, including PubMed, Embase, Web of Science, and Cochrane library were searched for randomized controlled trials (RCTs), regarding the effect of vitamin D on urinary albumin excretion in DN patients. The study selection and data extraction were conducted by two reviewers independently, and statistical analysis was performed using RevMan software, version 5.2. A total of nine RCTs including 1547 subjects were qualified. There were 815 participants in the study group and 732 in the control group. The fixed-effect model was used to analyze urinary albumin creatinine ratio (UACR) and urinary albumin excretion ratio (UAER), and the pooled standard mean difference (SMD) was -0.24 (95% CI: -0.39 to -0.09), P = .002, and -0.57 (95% CI: -0.71 to -0.43), P < .00001; respectively. These findings indicated that vitamin D-treated patients had a statistically significant reduction in UACR and UAER. High-quality RCTs are still required.

The pandemic of COVID-19 emerged in December 2019. Although numerous features of the illness have been investigated, the impact of disease on those patients with underlying diseases, is still a major problem. The aim of this multicenter, cohort study, was to determine the clinical manifestations of COVID-19 in peritoneal dialysis (PD) patients. Five hundred and five patients, receiving PD, were enrolled in this study, out of which 3.7% had coronavirus infection. Fever was the most common symptom (63.2%). The hospitalization rate was 10.5, 21.1% required admission to intensive care units (ICU) and the mortality rate was 21%. The most common cause of infection included close contact with the infected individuals and lower rates of protective equipment use. Although the incidence of COVID-19 among PD patients is low, the severity of the disease and the mortality rate are quite high. Vaccination and adherence to preventive measures are strongly recommended in PD patients.

Introduction. Early diagnosis of diabetic nephropathy (DN), the leading cause of death in diabetic patients, is an important issue in preventing and reducing the disease burden for patients and the healthcare system. In this study, we aimed at investigating the value of color doppler ultrasonography in the diagnosis of early diabetic nephropathy (DN). Methods. Two hundred and thirty-eight diabetic patients, were enrolled in this study and were categorized into, either control (n = 109) or study group (n = 129), according to 24 hours urinary albumin excretion rate (UAER), from January 2015 to March 2021. The morphologic findings of the kidneys were observed and compared, in both groups, by color doppler ultrasound technique, and blood flow of renal arteries was also measured, at all levels. Fasting plasma glucose (FPG), uric acid, homocysteine, beta-2- microglobulin, cystatin C, hemoglobin A1c (HbA1c) and CRP were also extracted from their laboratory results. Results. Compared to the control group, the study group had lower intrarenal arterial end-diastolic blood flow velocity (EDV) and higher arterial resistance index (RI) (P ~ < .05). A significant diagnostic value of intrarenal arterial EDV and RI was found for early detection of DN (P ~ < .05). Intrarenal arterial RI and EDV showed positive correlations with UAER, FPG, uric acid, homocysteine, beta-2-microglobulin, cystatin C, HbA1c, and CRP (P ~ < .05). Conclusion. Color doppler ultrasound markers of renal and intrarenal arteries has a high diagnostic value for DN at its early stage.

Introduction. Hydronephrosis, a condition that is mostly congenital, is considered as the most common type of pediatric urinary tract disorder. The aim of this study was the evaluation of the prognosis and outcomes of hydronephrosis in cases of congenital hydronephrosis. Methods. In a cross-sectional study, run in a tertiary clinic of pediatric nephrology, from 2015 to 2020, patients with fetal hydronephrosis were selected. Ultrasonography, urinalysis and kidney function tests were ordered for all patients and in the presence of hydronephrosis, repeated ultrasonography, voiding cystourethrography and dimercaptosuccinic acid scan were performed. In cases with evidence of obstruction, a diethylenetriamine pentaacetic acid scan and relative surgical procedures were performed. Results. Among 141 cases, mean age was 8 ± 1.4 years and 80.9% were male. Partial or complete obstruction in the right and left kidney was found in 16.3 and 24.8% of patients, respectively. The degree of hydronephrosis was mild in 46.1%, moderate in 39%, and severe in 9.2% of the patients. At the last follow-up period, hydronephrosis recovered in 46% of the patients, while 54% experienced persistence or exacerbation of the disease. Meanwhile, 7.1% of patients showed neurogenic bladder, 19.1% urinary tract infection and 22.7% urinary stones. Conclusion. Our study revealed that fetal hydronephrosis ends in complete recovery following birth in 46% of the cases. However, in cases experiencing persistent or exacerbating hydronephrosis, optimized treatment and/or surgical intervention are required.

Introduction. Currently There is no noninvasive chemical biomarker, available for evaluating volume status, in individuals with endstage kidney disease (ESKD). This study aimed to determine the relationship between copeptin level and volume status in hemodialysis patients. Methods. This clinical trial enrolled 84 patients with ESKD (Mean age ± SD: 54.31 ± 15.47) on maintenance hemodialysis (3-times weekly, 4h /session). Plasma levels of Hb, copeptin, HCT, Na, and BUN, patients’ weight, systolic and diastolic blood pressure and mean arterial pressure were measured, before and after hemodialysis. Age, sex, etiology of kidney failure, and duration of dialysis were also recorded., and the correlation between copeptin level and all variables was evaluated. Results. There was a significant positive correlation between copeptin level and Hb (r = 0.313, P < .05), and HCT (r = 0.25, P < .05), while a negative association was found between copeptin level and Na (r = -0.051, P > .05) and IDWG (r = -0.05, P > .05). Although copeptin concentration was higher in females before (929.23 pmol/L) and after dialysis (783.3 pmol/L) than male patients (657.05 and 697.45 pmol/L), the mean copeptin changes was higher in male (205 pmol/L) than female (197 pmol/L) (P > .05). The level of copeptin decreased (P > .05) but the level of Hb (P < .05), HCT (P < .05), and Na (P > .05) were increased after dialysis compared to pre-dialysis period. Conclusions. Copeptin could be used as a surrogate marker for the diagnosis of volume status in hemodialysis patients.

Introduction. The rates of morbidity and mortality in patients receiving routine hemodialysis have been demonstrated to be significantly affected by the dose of HD. As the national and international standards for determination of dialysis adequacy vary among countries, it is necessary to investigate the optimum criteria for HD adequacy. In this study, we aimed at comparing HD adequacy, through two methods of OCM with electrical conductance, and blood-driven Kt/V of urea, in the largest hemodialysis center in Iran. Methods. The value of UC, as an indicator of HD adequacy, was measured 301 times in 120 HD patients via two methods of OCM and blood-driven clearance of urea. For urea- driven Kt/V, two blood samples, each 2 milliliters, were taken from the patient, one before and one after a HD session. For OCM, Fresenius 4008 dialysis machine was set online once the patient was receiving HD. The results of these two methods were analyzed regarding the correlation with patients’ demographics, BMI, required weekly HD sessions, type of HD access, type of dialyzers, hematocrit, UDV, ultrafiltration, and blood flow rate. Results. The mean values of UC obtained from blood samples and OCM were almost similar and not significantly different (1.20 vs. 1.11, P = .50). UC values, measured by laboratory assessments were significantly associated with gender, BMI and UDV, while UC values from OCM were significantly associated with gender, BMI, dialyzer type, UDV and ultrafiltration. Conclusions. We conclude that OCM can be used as an effective substitute for laboratory assessment in HD centers to assess HD adequacy.

Introduction. Cilostazol is an antiplatelet agent, that has been recently used as an adjunctive therapy in the management of diabetic foot ulcers. Headache, diarrhea, palpitations, and edema are reported as common side effects. Case Presentation. A 53-year-old woman was admitted to hospital, with decreased urine output and increased serum creatinine level. She had taken Cilostazol for the first time, for only one day, so the diagnosis of acute kidney injury, probably drug-induced acute interstitial nephritis, due to Cilostazol use, was made. Her kidney function did not improve despite Cilostazol discontinuation and therefore, empirical corticosteroid therapy was initiated. Her urine output increased and her serum creatinine level significantly decreased, on the third day of treatment. She was discharged with acceptable kidney function. Follow-up visits showed gradual normalization of serum creatinine in the next 62 days. Conclusion. Based on our case, we may draw the conclusion that, Cilostazol may cause nephrotoxicity at any point after ingestion.

Renal sarcoidosis frequently causes granulomatous interstitial nephritis, but clinically relevant nephritis is uncommon. IgA nephropathy caused by sarcoidosis is usually associated with milder stages of renal dysfunction, and only one case of rapidly progressive IgAN has been reported to date. We present an interesting case of a patient with a rapidly progressive form of IgA nephropathy caused by sarcoidosis that was successfully treated.