Iranian Journal of Kidney Diseases
Volume:16 Issue: 6, Nov 2022

The newest Kidney Disease Improving Global Outcomes (KDIGO) guideline recommendations were investigated mainly for the care of adult kidney transplant recipients, but no guideline exists for the management of pediatric transplant recipients. This review provides update recommendations in the management of pediatric kidney transplantation. Four electronic databases, PubMed, EMBASE, Google Scholar, and Web of Science were searched systematically for the last two decades, using Mesh terms in English language. The Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach was used for grading the quality of the overall evidence and the strength of recommendations for each outcome across the studies. The overall quality of evidence categorized as high (A), moderate (B), low (C), or poor (D). The strength of a recommendation was determined as level 1 (recommended) or level 2 (suggested). The ungraded statements were determined on the basis of common sense to provide general advice. Of the 317 citations which were screened for the evidence review, 62 were included in data extraction. The included studies were randomized controlled trials, prospective cohorts and cross-sectional, descriptive, and review studies. Of the 115 statements, 56 (48.6%) were graded 1 (we recommend), 34 (29.5%) were graded 2 (we suggest), and 25 (21.7%) were ungraded statements. Altogether, only 22 (19.1%) of recommendations reached the “A” or “B” levels of quality of evidence. The pediatric kidney transplant recipients are different from adult recipients regarding the primary kidney diseases, surgical techniques, drug metabolism, adherence to medications, growth and neurocognitive development and immunization needs prior to transplantation.

Increased risk of graft rejection could be the consequence of COVID-19 in kidney transplant recipients (KTRs). We report two cases of kidney transplant (KT) with stable graft function who experienced antibody-mediated rejection (ABMR) following recovery from COVID-19. It seems that reduced immunosuppression during the acute illness, is the main explanation for post-COVID-19 ABMR. However, the inflammatory state associated with COVID-19, as well as direct cytopathic effects of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can predispose the kidney allograft to rejection. There is no definite guideline for the modification of immunosuppressives during COVID-19 in kidney transplant recipients. However, re-institution of full-dose immunosuppressives soon after recovery from COVID-19 and frequent outpatient follow-up visits are recommended.

Cardiovascular disorders are the leading cause of mortality and morbidity in patients with end-stage kidney disease (ESKD). We aimed to describe different patterns of cardiovascular abnormalities, the hemodynamics and the outcomes of ESKD patients referred to a tertiary center for heart failure programs, in detail.

In this cohort, all ESKD patients who were referred by nephrologists for cardiovascular consultation and scheduled for right heart catheterization between July 2009 to October 2021, were assessed. The outcome of the selected patients in terms of all-cause mortality or successful kidney transplantation was followed up until January 2022.

A total of 73 patients (54.7% male) were selected. With the exception of four patients who had a specific cardiovascular disease, the remainder were referred due to a low left ventricular ejection fraction or pulmonary hypertension in order to determine the potential for kidney transplantation. Most of the patients (63%) were categorized as heart failure with reduced ejection fraction (HFREF). More than 87% of study population had pulmonary hypertension (PH). Post capillary PH (isolated or combined) was the most common type of PH (81%). The median interquartile range (IQR) of time to kidney transplantation or all-cause mortality was 1 (0.5 to 2) year. Twenty-five (36.2%) patients received a successful kidney transplant. The all-cause mortality rate was 28.8%. Older age, lower left ventricular ejection fraction (LVEF) and presence of pericardial effusion were independent predictors of all-cause mortality in multivariate analysis.

ESKD patients with HFREF and/or pulmonary hypertension will have remarkable improvement in terms of their cardiac performance parameters following kidney transplantation.

Staphylococcus aureus (S. aureus) is one of the most frequent causes of infection around the world. Insertion of intravascular catheter and formation of biofilms by methicillinresistant Staphylococcus aureus (MRSA) have contributed to the increased risk of infection, and morbidity and mortality rates. Biofilms formation on intravascular catheters and other medical devices are of major postoperative concerns because biofilms are often the source of persistent and difficult-to-treat bacterial infections. This study aimed to evaluate different genetic patterns of this bacterium in samples collected from dialysis patients of Nikan hospital.

In this descriptive cross-sectional study 30 samples from the removed catheters of patients suspected to have S. aureus infection and admitted to the dialysis ward of Nikan hospital were collected and phenotypic evaluations were done to confirm the type of the infectious species. Evaluation of antibiotic resistance of bacterial samples using Kirby-Bauer method was done. Biofilm production of the samples was assessed by the 96-plate microtiter method. The existence of two genes hla and hlb were evaluated using Multiplex PCR.

The biofilm production test showed that 60% of the samples were able to produce strong biofilms. Multiplex PCR results revealed that both hla and hlb genes were expressed in 93% of the samples, while, hlb gene alone was expressed in 53% of cases.

The results of this study provide significant insight into the virulence gene makeup of catheter-colonizing S. aureus strains, and will assist in developing a more targeted treatment approach for persistent S. aureus biofilm contamination of medical devices.

We intended to explore the prevalence of chronic kidney disease (CKD) and its different stages, as well as CKD associated variables in the adult population in Isfahan province, Iran.

Adults aged ≥ 18 were recruited in a cross-sectional study from 2017 to 2019. Data including demographics, anthropometrics, and laboratory findings were collected from each subject. The equation of chronic kidney disease- Epidemiology Collaboration (CKD-EPI) was used to estimate glomerular filtration rate (eGFR), and eGFR and UACR values were utilized to determine the stages of CKD.

Data from a total of 3374 subjects was analyzed. The mean age of participants was 49.3 ± 14.09 years and 59.3% were female. The prevalence of CKD was 18.5%. Only 0.25 and 3.5% of the population were in CKD stage 3 and 4, while most of the patients were in CKD stage 2 (7.6%) and stage 1 (7.1%). CKD patients were mostly on refined grains diet and used lesser dairy products compared to healthy participants. Variables including systolic blood pressure (OR = 1.018; P < .001), diastolic blood pressure (OR = 1.005; P < .05), fasting blood sugar (OR = 1.011; P < .001), female sex (OR = 1.319; P < .05), body mass index (OR = 1.030; P < .05), married status (OR = 1.335; P < .05), and smoking (OR = 1.529; P < .05) were significantly associated with increased risk of CKD in the logistic regression analysis.

According to our results, the prevalence of CKD, especially stages 1 and 2, is quite high in central part of Iran. These findings help us to improve the screening for CKD patients and perform larger scale studies to identify the challenges ahead.

BK virus nephropathy (BKVN) is an important complication of kidney transplantation and kidney biopsy remains the gold standard for its diagnosis. Urine/serum polymerase chain reaction (PCR) is a more sensitive diagnostic method, although it has some potential limitations.

  This study enrolled all kidney transplant recipients who underwent kidney transplant biopsy, collected from three medical centers. Urine and serum PCR results of the patients were also collected from the molecular laboratories. The cut-off value for positive viral DNA load in serum and urine were > 104 and > 107 copies/mL, respectively. Sensitivity, specifity, positive and negative predictive values (PPV, NPV) and cut off values for PCR results were compared with pathologic diagnosis among laboratories.

Among 369 biopsy samples, 33 (8.9%) had definite diagnosis of BKVN. PCR results were available for 138 cases. Three patients with definite BKVN had negative PCR results. In 22 patients, PCR was positive without evidence of BKVN. The overall sensitivity, specificity, PPV and NPV of PCR for detecting BKVN, based on a unique cut-off value, were 88, 81, 51, and 97%; respectively. The overall accuracy of PCR in all laboratories was high (82 to 86%), however significant inter-laboratory differences in sensitivity and specificity was found . A 2-log difference in threshold value for positive results was observed in one laboratory.

PCR may show a significant variability between different laboratories. Interpretation of PCR results using a single cut-off value for all laboratories, may decrease the sensitivity for the diagnosis and screening of BKVN.

Numerous factors have been involved in exercise-induced acute kidney injury (EIAKI), such as using non-steroidal anti-inflammatory drugs following exercise and idiopathic renal hypouricemia (IRHUC). IRHUC is an autosomal recessive inherited disorder characterized by impaired tubular uric acid transfer, impaired reabsorption, and accelerated uric acid secretion. Some IRHUC patients have been shown to have EIAKI. A 27-year-old police officer was admitted to the hospital due to anorexia and a serum creatinine level of 18 mg/dL, after a “tug-ofwar” game. After one dialysis sessions per day over five days, his creatinine dropped to 1.3 mg/dL. Six months later, he developed bilateral flank pain and red discoloration of urine, following a 300-meter chase of a convict, and his creatinine level increased to 2.3 mg/dL, which was corrected with proper hydration alone. Recurrent acute kidney injury can be due to hereditary renal hypouricemia, which should be considered among differential diagnoses for patients.