Nephro-Urology Monthly
Volume:5 Issue: 3, Jul 2013

Patients presenting with nephrotic syndrome with or without nephritic illness rarely come across with the diagnosis of ‘C1q nephropathy’. This entity is purely diagnosed with the help of immunofluorescence like IgA nephropathy. Clinical presentation is heterogenous, ranging from nephrotic range proteinuria to sub-nephrotic state; and with or without hematuria / renal insufficiency. Similarly, the concept of ‘C1q nephroapthy’ has periodically evolved since its original description by Jenette and Hipp in 1985. Here the pathophysiology, histologic findings / diagnostic and therapeutic options in patients with C1q nephropathy are discussed..

Prostate cancer is a prevalent disease with a high impact on patients’ morbidity and mortality. Despite efforts to profile prostate cancer, the genetic alterations and biological processes that correlate with disease progression remain partially elusive. The purpose of this study is to review the recent evidence relating to the initiation and progression of prostate cancer in relation to the familial correlation of the disease, the genetic aberrations resulting in prostate cancer and the new molecular biology data regarding prostate cancer.. A Medline database search identified all the existing publications on the molecular events associated with the pathogenesis and evolution of prostate cancer. Particular emphasis was given on the specific genetic phenomena associated with prostate cancer.. Like other cancers, prostate cancer is caused by an accumulation of genetic alterations in a cell that drives it to malignant growth. Specific genes and gene alterations have been suggested to play a role in its development and progression. Aneuploidy, loss of heterozygosity, gene mutations, hypermethylation and inactivation of specific tumour suppressor genes such as GSTpi, APC, MDR1, GPX3 and others have been detected in prostate cancers, but generally only at a low or moderate frequency. The androgen receptor (AR) signalling pathway may play a crucial role in the early development of prostate cancer, as well as in the development of androgen-independent disease that fails to respond to hormone deprivation therapies. Other alterations linked to the transition to hormone-independence include amplification of MYC and increased expression of ERBB2 and BCL2. Inflammatory changes may also contribute to the development of prostate cancer.. The identification of specific molecular markers for prostate cancer may lead to its earliest detection and better prediction of its behavior. The better understanding of the molecular events affecting prostate cancer progression may result in the introduction of new drugs to target these events thus providing a potential cure and a tool for prevention of this very common disease..

In 1981, Mitrofanoff described a procedure to create a continent urinary stoma for clean intermittent catheterization. Since then several procedures have been described including Yang-Monti ileovesicostomy for effective catheterization.. We report on our experience from the use of Monti’s procedure in children at our center..Patients and Children < 18 years of age undergoing urinary diversion/reconstruction with Yang-Monti’s procedure for congenital conditions or neuropathic bladder formed the study group. All these children, post-operatively were taught clean intermittent catheterization (CIC) and put on a regime using a 14/16 Fr catheter every 3 hours. The children were followed regularly at 3, 6, 12, 18 and 24months post-operatively, with special attention paid to any problems with catheterization and incontinence.. During the period from Jan 2000 to Dec 2011, at our center, 19 children less than eighteen years of age underwent urinary diversion with Yang-Monti’s catheterizable stoma. The indications for urinary diversion was neuropathic bladder in eight, exstrophy bladder in seven, valve bladder syndrome in three and persistent urethral stricture in one. None of the children found CIC difficult during the post-operative period and there was no hindrance to the passage of the catheter.. Although the appendix remains the tissue of choice for creation of catherterizable stoma, the Yang-Monti ileovesicostomy is effective, convenient conduit for children. Long-term complications are minimal and children find this comfortable to do CIC..

Seroconversion following Hepatitis B virus (HBV) vaccine in hemodialysis (HD) patients has been shown to be suboptimal. Nutritional and immunological factors were shown to influence the seroconversion related to HBV vaccination in HD patients. Resistance to erythropoiesis stimulating agents (ESA) for correction of anemia has also been shown to be associated with nutrition and inflammation in these patients.. The aim of the current study was to analyze the relationship between anti-HBs response and erythropoietin (EPO) resistance in HD patients..Patients and Demographics, clinical characteristics, laboratory parameters and the data about vaccination status were obtained from dialysis charts and vaccination registries retrospectively. To calculate the EPO resistance ESA hypo responsiveness index (EHRI) was used. The EHRI was calculated through deviding the weekly dose of EPO by per kilogram of body weight divided by the hemoglobin level. Patients were divided into non-seroconversion (anti-HBs titers were < 10 IU/L) and seroconversion groups (anti-HBs titers were ≥ 10 IU/L) after completion of the four-dose vaccination schedule.. In total 97 patients were enrolled. For the entire group, stepwise linear regression analysis revealed that square root transformed anti-HBs levels were independently associated with age (P = 0.016), blood urea nitrogen (P = 0.019), high sensitive C-Reactive Protein (P = 0.009), and square root transformed EHRI (P = 0.019). Logistic regression analysis have also demonstrated that blood urea nitrogen (P = 0.002), creatinine (P = 0.046), albumin (P = 0.01) and square root transformed EHRI (P = 0.011) were independently related to seroconversion.. EPO resistance was negatively associated with anti-HBs levels and seroconversion. More studies are needed to highlight the underlying mechanisms regarding EPO resistance and response to HBV vaccination in HD patients..

Diabetic nephropathy (DN) is one of the life-threatening disorders characterized by persistent albuminuria, raised arterial blood pressure, a lowered glomerular filtration rate, and high risk of cardiovascular morbidity and mortality. The vascular genes ACE (Angiotensin-converting enzyme), and PPARG (peroxisome proliferator activated receptor gamma) are involved in alterations in vascular endothelium, and are suggested to play a role in the susceptibility of diabetic nephropathy.. The aim of our study was to find out the role of ACE ID and PPARG P12A polymorphisms in genetic susceptibility of diabetic nephropathy in south Indian population..Patients and A total of 54 cases with diabetic nephropathy and 67 control subjects with diabetes were enrolled for our study. DNA was isolated from peripheral blood leucocytes, and genotyped using PCR-electrophoresis (ACE ID) or PCR-RFLP (PPARG P12A) methods.. ACE ID genotypes followed Hardy-Weinberg equilibrium in both cases and controls. But P12A genotypes deviated from Hardy-Weinberg equilibrium in diabetic controls. Chi2 test was applied for the analysis of genotypic distributions in genotypic and dominant models. Odds ratios were also calculated. No significant differences in genotype frequencies of ACE ID and PPARG P12A polymorphisms were found on comparing patients with diabetic nephropathy with diabetic controls. The synergistic role of ACE ID* PPARG P12A interaction, did not show any association in patients with diabetic nephropathy when compared to diabetic controls.. In conclusion, the ACE and PPARG genes do not have a key role in conferring risk for diabetic nephropathy..

Nephrotoxicity and hepatotoxicity are side effects of Cisplatin (CP) therapy.. We investigated the role of gender in CP-induced nephrotoxicity and hepatotoxicity.. Low dose of CP (1 mg/kg/day; ip) was administered daily to male and female Wistar rats for 15 consecutive days. Serum creatinine (Cr), blood urea nitrogen (BUN), malondialdehyde (MDA), nitric oxide (NO) metabolite, and magnesium (Mg) levels were determined.. The percentage of weight loss and the serum levels of MDA and nitrite in male and female animals were not statistically different. However, the serum levels of BUN, Cr, Mg, and kidney MDA levels, and kidney weight and damage score were significantly greater in males than in females (P < 0.05).. CP-induced nephrotoxicity is gender related for which the mechanisms should be determined..

Omega-3 fatty acids carry major roles in mediating inflammation, immune response, lipid peroxidation and lipoprotein metabolism. Diversity of health benefits have been attributed to dietary supplementation with omega-3 fatty acids in transplant and nontransplant settings. Several studies in renal transplantation have suggested that supplementation with omega-3 fatty acids may lead to significant clinical benefits. However, the extents of these benefits are variable and published data had not coincided with positive findings.. The aim of this study was to evaluate the effectiveness of omega-3 supplementation on the lipid profile and lipid peroxidation in patients underwent kidney transplant..Patients and Thirty cases had been selected with stable allograft function following at least six months of transplantation. The serum levels of lipids including triglyceride, low density lipoprotein (LDL), high density lipoprotein (HDL), very low density lipoprotein (VLDL), total cholesterol and indices of lipid peroxidation (malondialdehyde and APO a1) were measured by biochemical techniques at the baseline. Two months following prescription of oral omega-3 (3 g/day), the biochemical measurements were repeated and the differences were analyzed.. Of thirty patients, 12 were male and 18 were female with the mean age of 45.3 ± 13.0 (18-65) years. At the baseline, the serum levels of MDA and APO B were 3.5 ± 1.3 and 148.3 ± 20.4 ng/dL respectively. At the end of two months following intervention, they were 3.2 ± 1.2 and 145.7 ± 19.0 ng/dL, respectively (P > 0.05). Correspondingly, at the baseline the serum levels of triglyceride, LDL, VLDL and total cholesterol were 171.1 ± 58.7, 106.9 ± 31.8, 42.2 ± 4.0, 145.7 ± 33.2 and 181.2 ± 35.1 mg/dL and after intervention they were 162.4 ± 82.5, 99.4 ± 35.1, 44.6 ± 6.3, 140.3 ± 33.1 and 170.9 ± 38.3 mg/dL, respectively (P > 0.05). There was no significant difference between the males and females in this instance.. Our results seem to indicate that oral omega-3 may promote the lipid profile and indices of lipid peroxidation in patients following kidney transplantation however extents of these effects are not significant..

In candidate patients for permanent hemodialysis or dialysis on a regular basis, an appropriate vascular access has great importance. The best permanent access is AVF (arterio venous fistula). Use of a technique to create AVF with better patency seems to be logical.. The present study aimed to compare the efficacy rate of AVFs using two different anastomosis methods; Side to Side (STS) versus End to Side (ETS) and to determine whether the different approaches render any preferences or complications..Patients and Sixty end stage renal disease (ESRD) patients were included in this clinical trial in two assigned groups of 30 patients. In one group end to side method to create AVF was used while in the other group Side to Side technique was applied for access in surgery. Both groups were followed for duration of 6 months to assess patency. For evaluating the quantitive variables, t-test was used while qualitative variables were measured using the chi-square and Fisher`s exact tests.. In the 6 months duration, 6 patients (20%) in the STS (side to side) group and 5 patients (16.6%) in the ETS (end to side) group experienced a non-functional AVF. In the ETS group the failure was generally a result of thrombosed access while in the STS group, 4 out of 6 patients with complications, experienced thrombosis while the other 2 patients had venous hypertension. The total failure rate was 18.3% and during the 6 months of follow up no significant difference was detected in the efficacy rate. Nevertheless, in case of longer follow ups, different outcomes could be seen.. This study demonstrated that there was no significant statistical difference between the functional patency rates of fistulae placed by STS or ETS methods..

Dyslipidemia after kidney transplantation is a frequent finding and is multifactorial. Immunosuppressive agents such as cyclosporine (CsA) can cause hypercholesterolemia.. As there were few reports with conflicting evidence on whether CsA related dyslipidemia is dose related and that CsA monitoring assays (trough level, C0, or two hour post dose level, C2) is a better predictor for dyslipidemia development; hence, the current study, in a large sample size, was designed to answer these questions..Patients and In the current retrospective cross sectional study, 1391 kidney transplant recipients were enrolled. All patients received CsA plus mycophenolatemofetile or azathioprine and prednisolone. Serum creatinine, CsA blood levels and lipid profile were measured after 12-14 h fasting. Mann-Whitney and Kruskal-Wallis, Pearson`s test and logistic regression were used for data analyses.. Mean age of 1391studied population was 38.7 ± 15 years old. Hypercholesterolemia and hypertriglyceridemia were observed in 58.9% and 86.6%, respectively and they were more significantly detected in cadaveric kidney transplantation. Dyslipidemia had weak correlation with age of recipient, serum creatinine, C0 and C2 levels of CsA. At logistic regression, serum creatinine was the only risk factor for hypercholesterolemia development after kidney transplantation (OR = 1.6, CI 95%: 1.4 -1.8).. Dyslipidemia is a common finding after kidney transplantation and has no correlation with CsA level. According to conflicting data on the precise effect of different factors in inducing dyslipidemia, prospective large sample size studies should consider better control of dyslipidemia..

Improvement in the outcome of organ transplantation is related to advances in patient selection criteria, organ preservation, operative techniques, perioperative care and efficacy of immunosuppressive agents.. We aimed to evaluate the effects of higher levels of arterial PaO2 in donors on DGF (delayed graft function)..Patients and Thirty patients over 18 years old with stage 4-5 chronic kidney disease (CKD) who received a kidney from living donors were enrolled. They were randomly grouped in to the case (n = 17) and control (n = 23) groups and were followed for 2 weeks after transplantation. Donors were exposed to 60% oxygen for at least 2 hours with a face-mask (venture mask) for 2 consecutive days before transplantation until arterial oxygen pressure increased in arterial blood gas to 200 mmHg. Neutrophil gelatinase associated lipocalin (NGAL), Interleuk-18 (IL-18), tumor necrosis factor- α (TNF-α) and transforming growth factor–β (TGF-β) could be good biomarkers for early diagnosis of kidney injury in renal transplant recipients; we assessed kidney function with these biomarkers.. Thirty living kidney transplantations including 17 cases and 23 controls were performed; female gender was more prevalent in recipients (n = 16, 54.1%). The mean age of recipients was 36.1 ± 12.4 (18-67) years old. DGF was detected in 2 (5.95%) individuals, from whom one was in the case group and the other one in the control group. In the univariate analysis, there was no significant correlation between age and biomarkers in urine and serum unless for the second serum NGAL (P = 0.02, r = -0.06) and second urine IL 18 (P = 0.03, r = -0.5) which had a negative correlation, and first urine TNF α (P = 0.02, r = 0.7) which had a positive correlation.. Oxygen therapy in the case group had no significant impact on protection from DGF..

Primary malignant lymphoma of the male external genitalia is extremely rare and it is even rarer in the penis. Because of its rarity, the possibility of delay in diagnosis and mismanagement is always there. It can present as a nodule, non-healing ulcer, stricture urethra or periurethral abscess. We report a case presenting first a nodule and later on as a non-healing ulcer which was diagnosed by corporal biopsy and managed successfully with chemotherapy..

Malignant peripheral nerve-sheath tumor (MPNST) is a high-grade malignant tumor of ecto-mesenchymal origin comprising approximately 10% of soft-tissue sarcomas. They tend to occur associated with neurofibromatosis or sporadically. Here we report a MPNST at an extremely rare location and behavior causing disappearance of the entire kidney. Patient evaluation included clinical, biochemical and radiological studies before treatment. Histological study revealed the rare diagnosis. Patient was asymptomatic at six-month follow-up after treatment..