Nephro-Urology Monthly
Volume:15 Issue: 3, Aug 2023

Colistin is a drug of choice against multidrug-resistance (MDR) bacteria. The most important side effect of colistin is nephrotoxicity, observed in 20 - 54% of patients. According to the studies that examined its antioxidant effect, it can reduce the kidney toxicity of various drugs, including colistin.

This study aimed to investigate melatonin’s effect on reducing colistin-induced kidney toxicity to use this drug with fewer complications.

This double-blind, randomized clinical trials with two groups involved 56 critically ill adults infected by MDR bacteria. The intervention group received 3 mg of oral melatonin simultaneously with intravenous colistin, which continued until the end of the treatment. The control group received placebo orally with IV colistin. We measured urine volume, blood creatinine, and BUN daily and determined the patients with renal failure using the KDIGO guideline. STATA software analyzed data with a P-value of less than 0.05 as the significance level.

Data obtained from recipients were analyzed for age (P-value = 0.357), gender (P-value = 0.945), weight (P-value = 0.438), APACHE score (P-value = 0.162). We did not observe significant difference in AKI criteria between the two groups. Compared to the control group, melatonin did not decrease blood creatinine (P-value = 0.110) and BUN (P-value = 0.567) and, made no change of urinary volume (P-value = 0.913). There was no decrease in kidney failure in the intervention group compared to the control group. As a result, we did not find a significant difference in outcome of the two groups.

We did not reveal any significant difference in the AKI criteria including blood creatinine,BUN,anddaily urinevolume with the addition of melatonin in participants receiving colistin; However, no complication was observed in the intervention group who received melatonin.

Sperm cryopreservation can reduce the quality of sperm. Antioxidants can improve sperm parameters by decreasing oxidative stress.

This study was performed to determine the effect of supplementing sperm freezing media with cysteamine on the quality of sperm after freezing.

This descriptive-analytical research was conducted at Omolbanin Center for Infertility Treatment in Dezful, Iran, in 2022. The samples included 60 men with normosperm based on the World Health Organization standards. Each sample was divided into three parts: 1. fresh semen group, 2. semen frozen with 10 mmol cysteamine supplementation, and 3. semen frozen without cysteamine supplementation. Viability, motility, morphology, total antioxidant capacity (TAC), and malondialdehyde (MDA) levels were evaluated. The results were described using SPSS version 22, and the significance level was considered P  0.05.

The mean of progressive motility was significantly higher in the fresh semen group (48.3 ± 4.74) compared to the two other groups. The mean progressive motility was significantly lower in the group without cysteamine supplementation (24.4 ± 3.38) than in the group with cysteamine supplementation (35.3 ± 4.9). Moreover, TAC was significantly higher in the group with cysteamine supplementation (816.6 ± 4.36) than in the other groups.We found that theMDAlevel was significantly higher in the group without cysteamine supplementation than in the other groups (36.5 ± 2.51).

According to the results of the present study, appropriate conditions for preserving the sperm parameters after cryopreservation could be created by adding cysteamine to the sperm cryopreservation media as an antioxidant effective on sperm parameters.

 Kidney injury (KI) is one of the complications of β-thalassemia patients.

 To determine the rate of KI and its relationship with plasma ferritin and CRP-hs in β-thalassemia patients.

 A total of 142 patients diagnosed with β-thalassemia (58.5% minor, 17.6% intermedia, and 23.9% major) were included in our study. In all patients, we measured plasma ferritin, CRP-hs, urine albumin, and serum creatinine and calculated the urine albumin to creatinine ratio (uACR). Based on uACR, we divided the patients into 2 groups: with KI (n = 19, uACR ≥ 3.0 mg/mmol) and without KI (n = 123, uACR < 0.3 mg/mmol).

 The ratio of KI in β-thalassemia patients was 13.4%. The median concentrations of plasma ferritin and CRP-hs in the KI group were significantly higher than in the non-KI group (P < 0.001). Plasma ferritin and CRP-hs were independent risk factors for KI (P < 0.001). At a cut-off value of 2.35 mg/L, plasma CRP-hs had a predictive value for KI (AUC = 0.841, P < 0.001). Similarly, plasma ferritin at the cut-off value of 2394.95 µg/L showed a predictive value for KI (AUC = 0.789, P < 0.001).

 The rate of KI was low in adult patients with β-thalassemia. Plasma ferritin and CRP-hs had a good predictive value for KI in β-thalassemia patients.

The DNA fragmentation index (DFI) is an essential marker in evaluating male fertility. Lifestyle is supposed to have a remarkable effect on enhancing this index and, subsequently, male fertility.

This study investigated the relationship between lifestyle habits and sperm DFI in infertile men admitted to Shahid Rahimi and Shohada-ye Ashayer hospitals in Khorramabad, Iran, from 2020 to 2021.

This cross-sectional descriptive study was performed on 222 infertile men. The samples were divided into three groups based on their sperm DFI: < 15%, 15 - 30%, and < 30%. In each group, alcohol consumption, smoking, age, and body mass index (BMI) were compared. The analysis was performed by SPSS software (version 22) using the chi-square test and one-way analysis of variance (ANOVA) test.

The mean age of patients was 37.45 ± 5.99 years. The DFI was < 15%, 15 - 30%, and 30% < in 119 (53.6%), 69 (31.1%), and 34 (15.3%) individuals, respectively. The mean age in the DFI groups of less than 15%, 15 - 30%, and more than 30% was 35.88, 38.17, and 41.52 years, respectively. The analysis showed a significant difference in the mean age of the three groups (P < 0.05). However, there was no significant relationship between smoking, alcohol consumption, and BMI with DFI (P > 0.05).

There was no significant relationship between lifestyle factors and DFI. However, large-scale studies are required to evaluate the role of these factors, as if their role in infertility is proven, lifestyle modification might be a potential method for managing infertility.

Acute kidney injury and proximal tubulopathy, resulting from Deferasirox administration, contribute significantly to acquired kidney failure. The role of antioxidants in preventing acute kidney injury remains inconclusive.

This study aimed to investigate the efficacy of vitamin E in preventing acute kidney injury and proximal tubulopathy in thalassemia major patients undergoing treatment with Deferasirox (Nanojade).

This study employed a randomized controlled trial conducted at the thalassemia center of Amirkabir Hospital in Arak, Iran. Sixty patients with thalassemia major receiving Nanojade at 20 mg/kg were included. The vitamin E group (n = 30) received a daily dose of 400 IU for a month, while the control group (n = 30) did not receive any vitamin E. The primary outcome measure was Acute Kidney Injury (AKI), defined as a greater than 50% increase in serum creatinine levels after seven days of Deferasirox administration. Additionally, proximal tubulopathy was assessed using serum phosphate (P), Venous Blood Gas (VBG), and urinalysis (U/A) after one month. Also, the Glomerular Filtration Rate (GFR) and blood urea nitrogen to creatinine ratio (BUN/Cr) were compared between the two groups.

No AKI or proximal tubulopathy occurrences were observed in either group, thus limiting the investigation into the preventive effect of vitamin E in these conditions. However, several noteworthy findings emerged from our analysis. Regarding GFR and blood urea nitrogen to creatinine ratio (BUN/Cr), there was no significant difference between the vitamin E and control groups after one month (P = 0.985 and P = 0.063, respectively). The increase in serum creatinine levels during the first week was significantly lower in the vitamin E group than in the control group (P = 0.019). However, there was no difference after one month (P = 0.984). Notably, the vitamin E group exhibited a significantly lower decrease in serum bicarbonate (HCO3) and pHafter a month (P = 0.013 and P = 0.003, respectively). The two groups had no significant differences regarding serum phosphate reduction (P = 0.391).

Administering vitamin E for one week effectively prevents an increase in serum creatinine levels and prevents the decrease of Deferasirox-induced PH and HCO3 in thalassemia patients. However, it does not significantly affect the GFR.

Voiding dysfunction in children involves various urinary symptoms and is often distressing. Tantrums, emotional outbursts typically seen in early childhood, may have an underlying relationship with urinary disorders. Existing research lacks evidence linking these two conditions. Therefore, we conducted the present study.

We aimed to investigate the potential link between tantrums and voiding dysfunction in children over 4 years old and to analyze the effects of individual tantrum symptoms on voiding dysfunction.

This case-control study was conducted on 96 children visiting Amir Kabir Hospital in Arak, Iran. The case group (n = 48) consisted of children with voiding dysfunction, and the control group (n = 48) included healthy children. The existence of tantrums was determined using the Parents’ Experience of Temper Tantrums in Children questionnaire.

Tantrums were significantly more common in the case group than in the control group (P = 0.004). Only the presence of screaming (P = 0.016) and throwing things (P = 0.022) showed significant associations with voiding dysfunction.

This study revealed a significant connection between voiding dysfunction and tantrums in children. Specific tantrum symptoms, such as screaming and throwing things, were found to be associated with voiding dysfunction. The findings emphasize a need for an integrated approach in pediatric care to address both urinary and behavioral aspects.

The coronavirus disease 2019 (COVID-19) infection has been associated with multiple opportunistic infections, including secondary cytomegalovirus (CMV) reactivation. Several cases of CMV syndrome and invasive CMV infection have been reported following severe COVID-19 infection worldwide during the COVID-19 pandemic in both immunocompetent and immunosuppressed patients. A case-control study conducted in India showed that during the first and second waves, CMV was the most common co-infection among fatal cases of severe COVID-19 lung infection in Indian renal transplant recipients.

We present 2 cases of CMV disease in postrenal transplant patients who developed clinical manifestations of CMV co-infection after mild COVID-19 infection during the fourth wave of COVID-19 infection in India. In both cases, CMV infection was treated by discontinuing mycophenolate mofetil and administering ganciclovir injections. However, the treatment resulted in 2 contrasting clinical outcomes: cure and death.

We reviewed the recent literature on the increased incidence of CMV reactivation after both COVID-19 infection and vaccination in immunocompetent and immunocompromised populations. Subsequently, we discussed some clinical questions relevant to the population of postrenal transplant recipients after the detection of mild COVID-19 infection.