Nephro-Urology Monthly
Volume:15 Issue: 4, Nov 2023

 Renal artery stenosis (RAS) is defined by a decrease in the internal diameter of one or both of the renal arteries. This can lead to renal insufficiency. RAS mostly occurs due to atherosclerosis; however, other conditions can cause this complication.

 We present a 66-year-old man who was initially presented with abrupt bilateral lower limbs and scrotal edema in Shahid Beheshti Hospital of Qom. The patient had been regularly visiting the nephrology clinic for mild CKD. Due to the increased levels of creatinine (Cr) and urea in serum, he underwent angiography with suspicion of RAS, and 99% stenosis was confirmed in the left renal artery. Immediately after the diagnosis, we subjected the patient to angioplasty. After removing the arterial stenosis, the patient passed 8 liters of urine during one day, and his symptoms, including generalized edema, weight gain, and dyspnea, were improved gradually. The patient was discharged after 8 days of hospitalization with dramatically improved kidney function and relatively good general conditions.

 This patient had an uncommon presentation for a unilateral RAS and significant narrowing in the healthy renal artery. Angioplasty and stenting yielded a satisfactory result as a definite and effective treatment, and the patient enjoyed a relatively normal life with preserved kidney function during 4 years of follow-up.

 A complete adherence to treatment is essential for patients undergoing hemodialysis treatment. This health behavior is the product of various overlapping variables that may change over time.

 This study aimed to investigate treatment adherence based on general health and demographic characteristics among hemodialysis patients.

 This was a descriptive-correlation research conducted based on structural equation modeling. The population included all patients with chronic kidney disease in Tehran, Iran, of whom 200 patients undergoing hemodialysis admitted to 2 medical centers from September to March 2022 were selected by convenience sampling. The data were collected using the General Health Questionnaire (GHQ) and End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ). The data were analyzed using correlation analysis and path analysis in SPSS v. 19 and SmartPLS v. 3.

 The results showed the direct and significant effect of general health (P = 0.001) and age (P = 0.017) on treatment adherence. However, sex, marital status, level of education, and duration of dialysis treatment had no significant effect on treatment adherence.

 Considering the power of general health and age in predicting treatment adherence, these two variables can be included in training, clinical, and psychological interventions.

 Healthcare-associated urinary tract infections (HAUTIs) are the most prevalent healthcare-associated infection worldwide. They can lead to major problems in hospitalized patients, including the increase in the length of the hospital stay, the cost of the hospitalization, and the inappropriate administration of antibiotics.

 We aim to investigate the prevalence and antibacterial sensitivity of various bacteria that cause HAUTIs.

 This cross-sectional study was conducted in three referral hospitals in Isfahan, Iran. Urine specimens were taken from urinary catheters of the patients with a suspected diagnosis of HA-UTI. Bacteria were identified by conventional methods, and antimicrobial sensitivity testing was performed by disk diffusion and E-test methods according to standard guidelines. Data was extracted from WHONET software, and further statistical analysis was performed by SPSS v.21.

 Among 283 HAUTIs, Escherichia coli was the most prevalent pathogen (33.2%), followed by Enterococcus spp. (25.9%), Klebsiella pneumonia (16.6%), Pseudomonas aeruginosa (8.8%), and Acinetobacter baumannii (8.8%). Escherichia coli was more common in females. The most active antibiotics against Gram-negative isolates were nitrofurantoin (69.8%), carbapenems (69.7%), and aminoglycosides (68.3%), and the most effective antibiotics against Gram-positive isolates were linezolid (100%) and nitrofurantoin (74.5%).

 This study showed that nitrofurantoin, carbapenems, and aminoglycosides are the most effective antibiotics against Gram-negative causes of HAUTIs. Also, linezolid and nitrofurantoin demonstrated significant activity against Gram-positive isolates. As a result, for the empiric treatment of nosocomial UTI in the area under study, judicious use of the mentioned antibiotics is recommended.

Urinary tract infections (UTIs) are one of the most prevalent infections among pediatric patients, making them a very common type of infection. Recently, there has been growing interest in the use of vitamin supplements as supplementary therapies. However, the existing research in this field appears to be fragmented and lacking coherence. Thus, this study aimed to provide a comprehensive overview of the current status of vitamin supplements' role in UTI treatment. We reviewed articles in PubMed and Google Scholar from 1950 to 2022. Vitamins C, E, and A have shown promising results as adjuvant therapies in UTI.

The urachus closes naturally after birth. Its opening leads to anomalies in which secondary complications, including urachus calculi, may be formed. This disease is often discovered incidentally in radiographic examinations and is rare in adults. The purpose of this study is to present a rare case of urachus calculus in an adult located precisely in the anterior wall of the bladder, at the junction of the bladder and urachus. Our case was a 38-year-old man with complaints of abdominal pain. The computerized tomography (CT) scan images showed a calculus attached to the anterior and inner wall of the bladder in inserting the urachus into the bladder. Cystoscopy showed the calculus is connected to the urachus duct without any mass/tumor. The collection of evidence suggests a calcified urachus. The patient was discharged with conservative treatment and a mild analgesic.

Urinary stone disease (USD) refers to the presence of stones or salt crystals within the urinary tract, with calcium stones accounting for approximately 80% of cases. Increased urinary calcium and phosphorus excretion predispose individuals to urinary stones, with hypercalciuria being the most significant risk factor. Vitamin D plays a pivotal role in modifying urine calcium and phosphorus excretion, and it enhances calcium and phosphorus reabsorption in the kidneys. Urinary stone disease is a recognized risk factor for chronic kidney disease (CKD) and may also lead to life-threatening complications such as perinephric abscesses, urosepsis, and urinary tract malignancies. The role of serum vitamin D and its effects on serum calcium and phosphorus in urinary stone formation have been subjects of controversy.

This study aims to evaluate the associations between serum calcium, phosphorus, and vitamin D levels and urinary stones.

This retrospective study involved two groups of 90 patients, one with urinary stones and the other without. Demographic and biochemical data, including serum calcium, phosphorus, and 25-(OH) vitamin D levels, were recorded for all patients. Patients were categorized into four groups based on their serum vitamin D levels: Excess, sufficient, insufficient, and deficient. The presence and characteristics of urinary stones were assessed using non-contrast CT scans.

The mean age of the patients was 54.62 ± 15.46 years. Laboratory investigations revealed mean serum calcium, phosphorus, and vitamin D levels of 9.56 ± 0.65 mg/dL, 3.53 ± 0.79 mg/dL, and 25.05 ± 12.96 ng/mL, respectively. This study demonstrated a significant correlation between serum calcium levels and the maximum diameter of urinary stones (correlation = 0.313, P-value = 0.005). No other significant associations were found between serum calcium, serum phosphorus, and serum vitamin D levels and the number of kidney stones, stone laterality, and type of kidney stone. There was also no significant difference between the two groups.

In conclusion, the role of serum calcium, phosphorus, and 25-(OH) vitamin D levels in urinary stone formation remains controversial. This study suggests that there is no significant association between serum calcium, phosphorus, or 25-(OH) vitamin D and urinary stones, except for a positive association between serum calcium and the diameter of the stone.