Iranian Journal of Kidney Diseases
Volume:17 Issue: 3, May 2023

Angiotensin receptor blockers (ARBs) are commonly prescribed in pediatric hypertension because of the fundamental role of the renin-angiotensin-aldosterone system in the pathogenesis of hypertension. We, therefore, aimed to systematically review articles that investigated efficacy and safety of ARB agents in the pediatric population aged over six years. To do so, the databases of Web of Science, PubMed/MEDLINE, and Scopus were searched to conduct a systematic review by using the following keywords: (“angiotensin receptor blocker” OR “valsartan” OR “losartan”) AND (“pediatric” OR “children” OR “child”) AND (“high blood pressure” OR “hypertension”). Finally, 12 studies were included in our review, and we found that almost all of them supported the effectiveness and tolerability of different ARB agents. Candesartan cilexetil lowered blood pressure (BP), with a 9 mmHg decline in both systolic and diastolic BP, and proteinuria after four months of treatment. Valsartan and Losartan similarly were shown to be effective in lowering BP in a dose-dependent manner. Headache, dizziness, upper respiratory infection, and cough were the most reported side effects. However, almost all reviewed studies indicated that the safety profile was satisfactory. In conclusion, ARBs are beneficial and well-tolerated antihypertensive medications.

Indoxyl sulfate (IS) and para-cresol (p-cresol) are uremic toxins with high protein bonding index that accumulate in the body with decreasing kidney function. The main purpose of the current investigation was to compare the concentration of p-cresol and IS in serum of the type II diabetic individuals with and without nephropathy.

Fifty-five patients with type II diabetes mellitus were divided into two groups: case and control. The case group consisted of 26 diabetic patients with nephropathy (proteinuria and serum creatinine below 1.5 mg/dL) without any other kidney diseases. The control group included 29 patients without diabetic nephropathy. Patients with advanced heart disease, cerebrovascular accident and other inflammatory or infectious diseases were excluded. Five mL of venous blood was taken from each patient in the morning fasting state. Then other laboratory tests including serum uric acid and creatinine levels, serum urea nitrogen, lipids and glucose were measured by standard methods. P-Cresol and IS levels were measured by the spectrofluorimetric method after extraction. We also filled out a checklist with information regarding the duration of their disease, medication history (oral or injectable), and other demographic information. There were no significant differences between the two groups regarding the investigated factors

There were no significant difference among the investigated factors between the two groups (P > .05) except for the serum creatinine, proteinuria and estimated glomerular filtration rate, where the mean values of cases were considerably higher than those of the controls. Serum IS and p-cresol levels were also significantly higher in the case group (P < .05).

According to the findings, it seems that IS, and p-cresol may play a role in the development of diabetic nephropathy and other complications of diabetes mellitus.

The research was an attempt to explore the potential impact of allicin on lipid peroxidation and oxidative stress in rats diagnosed with chronic kidney disease (CKD), and to determine its underlying mechanism.

Sixty rats were randomly divided into sham-operated, modelling, and allicin low, medium, and high dose groups. The histopathological structure of the kidney was observed in each group. Biochemical measurements were conducted to assess kidney function, including serum creatinine (Scr) and blood urea nitrogen (BUN), and 24-hour urine protein quantification. Levels of malondialdehyde (MDA), superoxide dismutase (SOD), reactive oxidative species (ROS), and reduced glutathione (GSH) in kidney tissue were measured, and mitogen-activated protein kinase (MAPK) and NF (nuclear factor) -κB protein levels were detected by western blotting.

They showed that allicin improved the pathological structure of renal tissue and protected renal function by reducing oxidative stress and lipid peroxidation via targeting the ROS/ MAPK/NF-κB pathway. Allicin increased SOD and GSH levels, while decreasing Scr, MDA, ROS, BUN, and the amount of protein excreted in urine over a 24-hour in medium and high dose groups. MAPK and NF-κB protein levels in medium and high dose allicin groups were lower than the modelling group.

Based on the results, it can be inferred that allicin may safeguard renal function in rats with CKD and has the potential to serve as a treatment for kidney ailments.

Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary kidney disease that can affect several organs. The clinical course of the disease varies among patients; some never become symptomatic, and others reach end-stage kidney disease (ESKD) in the 5th decade of their life.

This historical cohort study was conducted on ADPKD patients to investigate kidney and patient survival rates and related risk factors in Iran. Survival analysis and risk ratio calculation were performed using the Cox proportional hazards model, Kaplan– Meier method, and log-rank test.

Among the 145 participants, 67 developed ESKD, and 20 died before the end of the study period. Developing chronic kidney disease (CKD) at the age of ≤ 40, baseline serum creatinine level (SCr) of more than 1.5 mg/dL, and cardiovascular disease increased the risk of ESKD by 4, 1.8, and 2.4 times; respectively. Patient survival analysis revealed a fourfold increase in mortality if the glomerular filtration rate (GFR) declined more than 5 cc/min annually and if CKD was diagnosed at the age of ≤ 40. Vascular thrombotic events or ESKD in the course of disease increased the risk of death by approximately 6- and 7-fold, respectively. Kidney survival was 48% by the age of 60 and 28% by the age of 70. Patient survival was 86.05% at the age of 60 and 67.99% at the age of 70. Additionally, men had a significantly better renal function and survival than women.

Elevated baseline SCr and cardiovascular disease can increase ESKD risk in ADPKD patients. A rapid decline in GFR, ESKD development, and vascular thrombotic events increase the risk of death, but early CKD can affect both.

End stage kidney disease (ESKD) is a life-threatening disorder, which results from loss of function of more than 75% of renal tissue. Many treatment modalities have been attempted for this disease, but only renal transplantation, hemodialysis and peritoneal dialysis have been practically accepted. Each of these methods have certain disadvantages, therefore other treatment modalities are needed for better management of these patients. Colonic dialysis (CD) has been proposed as one of the appropriate candidate methods for the removal of electrolytes, nitrogen waste products and excess fluid, using intestinal fluid environment.

Super Absorbent Polymer (SAP) were synthesized to be used in CD. The intestinal fluid was simulated in terms of concentrations of nitrogenous waste products, electrolytes, temperature and pressure. The simulated environment was treated with 1 g of synthesized polymer at 37 °C. Concentrations of urea, creatinine and uric acid were measured before and after polymer treating.

Intestinal fluid simulator contained 40g urea, 0.3g creatinine, and 0.25g uric acid. SAP adsorbed up to 4000 to 4400% of its weight in the intestinal fluid simulator (1g polymer can absorb 40g fluid). The amount of urea, creatinine and uric acid decreased to 25g, 0.16g and 0.1g, respectively, in the intestinal fluid simulator.

The present study showed that CD is an appropriate method for removal of electrolytes, nitrogenous waste products and excess fluid from an intestinal fluid simulator. Creatinine is absorbed appropriately in SAP, as a neutral molecule. In contrast, urea and uric acid, as weak acids, are absorbed weakly in polymer network.

Malnutrition-inflammation-atherosclerosis is an independent risk factor and the most significant cause of death in dialysis patients, accounting for about 50% of deaths in the population. Moreover, the high incidence of cardiovascular-induced mortality in patients with end-stage kidney disease cannot be fully attributed to cardiovascular (CVD) risk factors only. Studies suggest that risk factors such as oxidative stress, inflammation, bone disorders, vascular stiffness, and energy protein loss are closely related to CVD and its associated mortality in these patients. Moreover, dietary fat is a crucial factor in CVD. This study focused on determining the relationship between malnutrition-inflammation and fat quality indicators among CKD patients.

This study was conducted on 121 hemodialysis patients aged 20 to 80 years in a teaching hospital affiliated to Hashminejad kidney center in Tehran, Iran during 2020 to 2021. Data on general characteristics and anthropometric indices were collected. The malnutrition-inflammation score was assessed by using MIS and DMS questionnaires and dietary intake was measured by a 24-hour recall questionnaire.

Out of 121 hemodialysis patients participating in the study, 57.3% were male and 42.7% were female. Anthropometric demographic characteristics showed no significant difference among diverse groups with heart disease (P > .05). There was no significant relationship between malnutrition-inflammation and heart disease indices in hemodialysis patients (P > .05). Furthermore, there was no correlation between the dietary fat quality index and heart disease (P > .05).

In this study, there was no significant relationship between the malnutrition-inflammation index and the dietary fat quality index with cardiac disease in hemodialysis patients. Further studies are needed to have a tangible conclusion.

Despite many advances in the development of knowledge and application of new immunosuppressive medications over the past two decades, the improvement has only been seen in the short-term outcome of kidney transplantation while the long-term survival of kidney transplantation has not significantly improved. Allograft kidney biopsy may help to determine the causes of allograft dysfunction which may change the treatment strategy.

In this retrospective study, kidney transplant recipients who underwent kidney biopsy in Shariati hospital during the years 2004 to 2015, at least three months after the kidney transplantation, were included for evaluation. Chi-square, ANOVA, post-hoc LSD, and T-test were used for data analysis.

A total number of 525 renal transplant biopsies were performed; 300 of them had complete medical records. The reported pathologies consisted of acute T-Cell mediated rejection (TCMR) (17%), interstitial fibrosis and tubular atrophy/chronic allograft nephropathy (IFTA/CAN) (15%), calcineurin inhibitor (CNI) nephrotoxicity (12.8%), borderline changes (10.3%), glomerulonephritis (GN) (8.9%), antibody mediated rejection (ABMR) (6.7%), transplant glomerulopathy (TG) (5.3%), normal (8.4%), and other pathologies (15.6%). C4d was positive in 19.9% of the biopsies. The pathology category had a significant correlation with allograft function (P < .001), but it had no significant relationship with age and gender of the recipient, donor and donor source (P > .05). Moreover, in about 50% of cases, treatment interventions were based on pathological results, which were effective in 77% of cases. The two-year graft and patient survival after kidney biopsy were 89% and 98%, respectively.

Acute TCMR, IFTA/CAN, CNI nephrotoxicity were the most common causes of allograft dysfunction based on the transplanted kidney biopsy. In addition, pathologic reports were helpful for proper treatment.