فهرست مطالب
Nephro-Urology Monthly
Volume:3 Issue: 2, Apr 2011
- تاریخ انتشار: 1390/01/10
- تعداد عناوین: 10
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Page 99BackgroundThe evaluation of fluid status is generally approached from clinical observation of body weight changes, congestion, edema, blood pressure and chest X-ray. However, evaluation on clinical grounds alone is not accurate enough in HD patients; moreover, no single method has emerged as a gold standard to assess the fluid status in chronic hemodialysis patients.ObjectivesThe aim of this study was to assess the fluid status among chronic hemodialysis patients using Doppler echocardiographic parameters including inferior vena cava diameter (IVCD) and its correlation to plasma atrial naturetic peptide (ANP).Patients andMethodsSixty subjects were included in this study, 40 patients on chronic hemodialysis and 20 subjects as control group. The subjects of this study were classified into three groups; group 1, 20 normotensive patients who were on hemodialysis for at least six months; group 2, 20 hypertensive patients who were on hemodialysis for at least six months; and group 3, 20 healthy subjects without history of cardiac disease (as a control group). The IVCD was measured in all groups by ultrasound and Doppler echocardiography to estimate the pulmonary flow and post dialysis plasma atrial naturetic peptide (ANP).ResultsA significant difference in the IVCD 2 hours after hemodialysis was seen between the hypertensive and the normotensive groups. In addition, we found that a significant difference in the peak pulmonary vein systolic velocity between the three groups. There was a significant negative correlation between the peak pulmonary systolic velocity to peak pulmonary diastolic and IVCD. In addition, there was a significant difference between mean ANP level among the three studied groups and the ANP was significantly correlated with IVCD in corresponding groups respectively.ConclusionsThe current study showed an increase in the IVCD and ANP as well as an increase S/D ratio in hemodialysis patients with hypertension than normotensive hemodialysis cases and the controls. Thus we emphasize the importance of assessment of fluid status using Doppler echocardiographic parameters as pulmonary venous flow using S/D ratio.
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Page 106BackgroundCytomegalovirus (CMV) is an important viral pathogen in patients undergoing organ transplantation.ObjectivesWe aimed to develop a molecular qualitative PCR assay for the detection of CMV DNA in clinical samples from renal transplant recipients.Patients andMethodsPolymerase chain reaction (PCR) was performed for the assessment of CMV replication in two groups of renal transplant patients. Furthermore, the sensitivity of PCR for detection of CMV DNA from plasma relative to leukocyte was tested.ResultsCMV DNA was detected in 33 (25.9%) samples of 127 renal transplant patients. From 33 patients with positive PCR test, 20 patients had clinical symptoms and 13 (33.4%) of the patients had no clinical symptoms of disease. Also, the sensitivity of PCR assay for detection of CMV DNA from leukocyte relative to plasma is more.ConclusionsThe results suggest that The CMV PCR might be a useful tool for the early identification of patients at high risk of developing CMV disease. Furthermore the best sample for identify CMV infection is peripheral blood leukocytes (PBL).
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Page 109BackgroundSurgical treatment of urethral strictures includes numerous options such as dilation, internal urethrotomy, stenting and reconstructive surgical techniques. Short uncomplicated strictures are generally amenable to complete excision with primary anastomosis. We performed a retrospective evaluation and analysis of outcome in patients who underwent any kind of treatment for urethral strictures.ObjectivesTo evaluate and analyze the outcome in patients who underwent treatment for urethral stricture disease over the last 15 years (May 1993 to June 2008), at a tertiary care centre, as well as to determine the treatment option to be utilized in different varieties of urethral strictures.Patients andMethodsWe reviewed 524 patients who underwent treatment for urethral strictures between May 1993 and June 2008. Mean follow-up was 68 months. Preoperative evaluation included clinical history, physical examination, urine culture, residual urine estimation, uroflowmetry, and retrograde and voiding cystourethrography. Since 2000 urethral ultrasound was also performed in all patients. Clinical outcome was assessed by comparing pre and post operative investigation and patient satisfaction.ResultsStricture etiology was catheter induced (15.36%), blunt perineal trauma (59.2%), instrumentation (12%), spontaneous (3.52%) and infection (10%). Stricture length was 0 to1cm (in 9.92%) 1 to 2 cm (in 32%), 2 to 3 cm (17.28%), 3 to 4 cm (24%) or 4 to 5 cm (8.8%) more than 5cm (16%). The success rates in these procedures were 93.6% (TAU-Tunica albuginea urethroplasty), 94.4% (USPBA-U shaped Prostato-bulbar Anastomosis), 91.7% (BMSU-Buccal Mucosa urethroplasty), 90% (IOU-Internal optic urethrotomy), 90.35% (dilatation) and 81% (two staged urethroplasty). There were 129 patients (25.49%) who experienced ejaculatory dysfunction. Good and fair results were considered successful. Of 524 cases 480 (91.6%) were successful and 44 (8.4%) were treatment failures.
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Page 114BackgroundChronic kidney disease (CKD) is a worldwide health problem. But despite to new routes of dialysis, mortality and morbidity is high. One of the most common symptom of CKD is anemia, especially is more obvious in stages 3 and 4.ObjectivesIn this study, the effects of erythropoietin on renal function were assessed by measurement of serum creatinine level.Patients andMethodsTwenty three adult patients with CKD in the stages 3 and 4, enrolled in study and serum creatinine level was monthly measured three months before need to prescribe the erythropoietin due to anemia resulting from CKD (hemoglobin less than 12g/dl) and continued 6 months after administration of the drug. Based on patient's needs, the drug was administered subcutaneously in a dose of 4000-6000 units per week so patient's hemoglobin level became more than 12g/dL. During the study, all patients who required to dialysis or kidney transplantation were excluded from the studyResultsMean of creatinine and 1/creatinine values in 4 stages including three-month before intervention, time to intervention, and the three months after the intervention and the six month after the intervention were 2.17 and 0.50; 2.45 and 0.45; 2.41 and 0.47; 2.30 and 0.49 respectively which were not statistically significant.ConclusionThe administration of recombinant human erythropoietin in stage 3 and 4 of chronic kidney disease, improves anemia with no impact on renal function.
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Page 118BackgroundPreviously we conducted three cross sectional studies of epidemiology of end stage renal disease (ESRD) in El Minia Governorate.ObjectivesThe aim of study was to ascertain prevalence, etiology and risk factors for ESRD during year 2007.Patients andMethodsPatients on renal replacement therapy (RRT) in El-Minia Governorate in 2007 was 1615. They were offered to participate in this study, standardized questionnaire was completed including demographics, family history, risk factors for ESRD, environmental exposure to toxins, and causes of death.ResultsPrevalence of ESRD was 367 per million populations. Renal replacement therapy was hemodialysis in 1550 (96%), peritoneal dialysis in 32 (2%) and renal transplantation in 33 (2%) patients. Only 950 (59%) of the patients included in the study, mean age was 47 ± 13 years, median 43, range (18 to 80), males Vs females (64% Vs 36%), death rate was 182/1000.ConclusionThis study indicates an annual increase of 59 new ESRD pmp patients than the study of year 2006.
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Page 122Background And AimsEpstein - Barr virus (EBV) can cause serious complications in kidney transplant patients. Current guidelines are recommended that both recipients and donors, be routinely tested for EBV IgG antibody before kidney transplantation and the aim of the study was to evaluate the value of this recommendation.Material And MethodsIn a cross sectional study from February 2009 to March 2010, we evaluated donors and recipients who referred to our kidney transplant center. Routine pretransplante laboratory testes including EBV IgG and IgM antibody were performed.ResultsA total of 112 people, 52 donors (29 male and 23 Female) and 60 recipients (38 male and 22 female) were included in the study. Mean age of donors and recipients were 31.3±6.7 years and 42.1±12.57 years, respectively. Marker of HBV and HCV infections were positive in only 1 and 2 recipients and negative in all of donors. EBV IgG antibody was positive in 70 percent of recipients (n=42) and 52 percent of donors (n=27) but there was no statistically significant difference between them (p =0. 053) and between males and females (p=0.94). EBV IgM antibody was negative in 97 percent of recipients (n=57) and 100 percent of donors (n=67).ConclusionThe seroprevalence of EBV infection among candidate for kidney transplantation in khuzestan is not very high compared to other provinces in Iran, although we should perform screening for EBV to avoid kidney donation from seropositive donor to seronegative recipient.
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Page 125BackgroundBotulinum-A toxin (BTX) administration appears to be useful in patients with high pressure neurogenic bladder.ObjectivesThe aim of this study was to evaluate the usefulness of cystoscopic injections of BTX in the detrusor wall in the treatment of children with overactive neurogenic bladder dysfunctions.Patients andMethodsThe prospective, non-placebo controlled study was conducted with the approval of Local Ethics Committee. The study group consisted of 31 girls and 34 boys with neurogenic bladder overactivity, aged from 1 to 14 and treated with Botulinum-A toxin (Dysport, Ipsen).ResultsBoth values of volumes of the catheterized urine and bladder volumes in urodynamic studies increased significantly after the therapy and it proved that the younger patient the more effective the percentage of volumes growth.ConclusionThe results showed that endoscopic administration of BTX improved functional parameters of urinary bladder in cases of children with neurogenic bladder and the method might represent an alternative approach to operative reduction of intravesical pressures.
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Page 129The diagnosis of emphysematous cystitis is made when gas is visualized within the bladder wall on radiologic or ultrasound imaging and typically develops as a complication of lower urinary tract infection from gas forming bacteria. Its presentation varies from being asymptomatic to severe abdominal pain and requires a high index of suspicion in susceptible individuals to make the diagnosis and avoid potentially serious complications. Here we present a case of emphysematous cystitis along with a brief review of the literature.
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Hypertension and Proteinuria in early Pregnancy: Preeclampsia, Acute Intermittent Porphyria or Both?Page 131We report a case of early onset recurrent preeclampsia in a patient with positive family history of preeclampsia and a newly discovered acute intermittent porphyria. A 28 years old patient was admitted to our Clinic, due to early onset of preeclampsia in her third pregnancy. She had refractory hypertension with tachycardia, facial flush, anxiety and difficulty in breathing. During hospitalization, she reported occurrence of opalescent orange to reddish morning urine, which turned dark after a while. The dipstick test revealed positive urobilinogen in the urine. The same sample of urine was tested for porphobilinogens in the urine (by the use of Ehrlich's reagent) which were found positive and also porphyrins which were found negative; therefore, her medication was switched to a beta blocker. She decided to terminate pregnancy and this was done in the next few days by the use of anesthetics that are approved for acute intermittent porphyria. At her check up one month after delivery, her blood pressure was stabilized and the coproporphyrine, porphobilinogen and porphyrins from single void urine were all negative. In the check up 2 months after delivery, proteinuria of 0.5 g/day was still present; however, it reached to normal range (1g/day) after six months. To our knowledge, this is the first case reported in the literature where superimposed preeclampsia occurs in a patient with newly discovered acute intermittent porphyria.