Iranian Journal of Kidney Diseases
Volume:8 Issue: 1, Jan 2014

Chronic allograft nephropathy is the major cause of kidney allograft loss, and recent advances in immunosuppression therapy do not alter the picture. Interstitial fibrosis and tubular atrophy is an early event that starts early after engraftment and even could be found in recipients with good allograft function. Serum creatinine and estimated glomerular filtration rate have limited clinical roles in estimating the histopathological changes and graft fibrosis. Recent progress in microRNA research has created a great promise to identify new diagnostic biomarkers and therapeutic targets in renal fibrosis.

The widespread use of prenatal ultrasonography results in increased recognition of congenital hydronephrosis, a therapeutic and diagnostic challenge. This study was conducted to investigate the natural course of prenatal hydronephrosis and the accuracy of postnatal APD in determining the outcome. All newborns with prenatal hydronephrosis were followed up by ultrasonography after birth. Voiding cystoureterography, diethylene triaamine pentaacetic acid renal scintigraphy, and dimercaptosuccinic acid renal scintigraphy were done if indicated. The receiver operating characteristic curve was plotted to determine the best cutoff for the anterior-posterior pelvic diameter (APD) to distinguish surgical from spontaneously resolving group. Of 178 neonates, 42 (23%) required surgery. The area under the curve for APD to predict the need for surgery was 0.925 with an APD cutoff of 15 mm. The diagnostic value of APD for determining the need for surgery was determined by sensitivity and specificity of 95.2% and 73.5%, respectively. Postnatal APD on ultrasonography has a valuable diagnostic accuracy for requiring surgery and provides a useful guide for parental counseling.

Cardiovascular diseases are the most common causes of death in chronic kidney disease (CKD) and kidney transplant patients. This study aimed to evaluate cardiac troponins in transplant recipients and CKD patients without cardiac symptoms. Two groups of patients (CKD and kidney transplant recipients) were evaluated for troponins T and I levels. These values were associated with renal replacement therapy and demographic and clinical characteristics of the patients. Eighty CKD patients and 80 kidney transplant recipients were studied. There was a significant difference in Troponins T and I levels were significantly higher in the CKD group than in the transplant recipients. In the CKD group, 14 patients (17.5%) had an elevated troponin T level and 8 (10.0%) had an elevated troponin I, all of whom were in stage 4 of CKD. None of the kidney transplant patients had a positive troponin. Among CKD patients, decreased glomerular filtration rate was associated with elevated troponin I level. Elevated troponin T level was significantly associated with age and decreased glomerular filtration rate. In multivariable analysis, significant associations were found between troponin T level and age, serum creatinine, and glomerular filtration rate. A significant relationship was also found between troponin I and cholesterol and glomerular filtration rate. The assessment of troponin T and I in CKD and kidney transplant patients shows that in patients with CKD and without any symptoms of acute coronary syndrome, serum level of cardiac troponins increase and it is linked to serum creatinine and GFR.

Procalcitonin is a sensitive biomarker for bacterial infections. Recent studies show a correlation between serum procalcitonin level and vesicoureteral reflux (VUR). The aim of this study was to evaluate the predictive value of procalcitonin in diagnosis of VUR in children with febrile urinary tract infection. One hundred and eight children aged 2 month to 12 years with febrile urinary tract infection were evaluated. Serum procalcitonin was measured before initiation of antibiotics. Standard voiding cystourethrography (VCUG) was performed in all children as the gold standard for detection of VUR. Sensitivity and specificity of a high procalcitonin level was evaluated using the receiver operating characteristic curve. Forty-eight patients (44%) had VUR at least in one kidney, including grade 1 to 2 in 12 patients (11.1%), grade 3 in 16 (14.8%), and grade 4 to 5 in 20 patients (18.5%). Procalcitonin level ranged from 0.05 ng/mL to 13.6 ng/mL. Procalcitonin level was significantly higher with increasing the grading of reflux. Comparing procalcitonin levels with VCUG results, a sensitivity of 97% and a specificity of 75% was obtained at a procalcitonin level of 0.59 ng/mL for diagnosis of VUR. There was a significant correlation between procalcitonin level and leukocytosis, erythrocyte sedimentation rate, and C-reactive protein.A high procalcitonin level may be used for prediction of all grades of VUR in children with febrile urinary tract infection. A low procalcitonin level may be used for avoidance of unnecessary VCUG in some low-risk patients.

The aim of this study was to determine the incidence of acute renocardiac syndrome (cardiorenal syndrome type 3) and its outcome in a suburban population in India. In an observational study, 100 patients admitted with acute kidney injury were evaluated. Acute renocardiac syndrome was documented in 29%. Acute gastroenteritis (46%) was the leading cause of acute kidney injury. Cardiogenic pulmonary edema (56%) was the most common cause of acute cardiac dysfunction. Only 42% of the patients with acute renocardiac syndrome had complete recovery of kidney function. Requirement of renal replacement therapy was found to be significantly high in patients with acute renocardiac syndrome (43% versus 9% in those with AKI and no cardiorenal syndrome) and was associated with high rate of mortality (17%). This study shows that the incidence of acute renocardiac syndrome is high and is associated with increased morbidity and mortality. Hence, there is a need for primordial prevention and early intervention on large scale.

Calcium dobesilate is an antioxidant drug and this study is aimed to investigate the effects of calcium dobesilate on gentamicin-induced nephrotoxicity. This experimental study was conducted on 40 male Sprague-Dawley rats. The rats were randomly divided into the following 5 groups: control, sham, gentamicin (100 mg/kg/d, intraperitoneal), gentamicin and calcium dobesilate (50 mg/kg body weight), gentamicin and calcium dobesilate (50 mg/kg body weight). Treatment was provided once a day in a 7-day period. At the end of the 7th day, plasma and urine samples were taken and the concentrations of creatinine, urea nitrogen, sodium, potassium, and osmolarity were measured in both samples. The level of oxidative stress in the left kidney tissue samples was also assessed by measuring malondialdehyde and ferric reducing antioxidant power.Calcium dobesilate intake with both doses led to a significant decrease in the elevated concentration of creatinine, urea nitrogen, and fractional excretion of sodium by gentamicin, and an increase in creatinine clearance and absolute excretion of potassium as compared to the gentamicin group. Furthermore, calcium dobesilate decreased tissue malondialdehyde and increased tissue ferric reducing antioxidant power at both doses, in comparison to those in the gentamicin group. Calcium dobesilate is capable of protecting rats against gentamicin-induced nephrotoxicity. This protective effect of calcium dobesilate is probably dependent on its antioxidant properties.

Urinary calculi in infants are relatively infrequent, but their incidence has increased in the recent decades. The aim of this study was to investigate the clinical presentation, metabolic risk factors, and urinary tract abnormalities in infants suffering from kidney calculus. A total of 152 infants were admitted between 2009 and 2012 with ultrasonography-proven urolithiasis. A Foley catheter was fixed and 24-hour urine samples were analyzed for calcium, citrate, oxalate, uric acid, and magnesium. For detecting cystinuria, qualitative measurement of urinary cystine was done by nitroprusside test. Urinary tract structural abnormalities were also evaluated. The mean age at the diagnosis of kidney calculus was 5.46 months (range, 15 days to 12 months). The most common clinical findings were restlessness and urinary tract infection. A family history of calculi was found in 67.1% of the patients and 68.4% were born to consanguineous marriages. Metabolic abnormalities and urinary tract abnormalities were found in 96.1% and 15.1% of children, respectively. Urinary tract abnormalities were more common in girls. The most common metabolic risk factors were hypercalciuria (79.6%) and hypocitraturia (40.9%). Hyperoxaluria and hypomagnesuria were found in about 28% of patients, both of which were associated with bilateral urolithiasis. These findings show that urinary metabolic abnormalities are very common in infants with urolithiasis. Appropriate evaluation of urinary metabolic parameters can lead us to proper diagnosis and treatment.

Changes in peritoneal membrane characteristics including epithelial-mesenchymal transition are an important problem in the maintenance of peritoneal dialysis (PD). This study reports a 3-year follow-up assessment of the effects of low-glucose degradation products (GDP) solution, including epithelial-mesenchymal transition. Adult patients who received continuous ambulatory PD between April 2001 and March 2007 were identified, and those who maintained on PD with the same solution for more than 3 years were included. Patients with an initial effluent score of 3 (fibroblastoid cells dominant in overnight effluent dialysate) were excluded. The patients were divided into two groups according to the dialysate: standard and low-GDP. The following were measured: cancer antigen-125, cell score, normalized protein equivalent of nitrogen appearance, dialysate-plasma creatinine and sodium ratios, and residual renal function. Cell score and peritoneal equilibration test were measured at 1, 6, 12, 18, and 24 months after the initiation of PD. Fifty patients were in the standard group and 76 in the low-GDP group. No significant difference in dialysate-plasma creatinine ratio was detected at baseline and at the end-point of follow-up between the two groups. Dialysate-plasma sodium ratio decreased significantly at the end-point of follow-up in the low-GDP group. Initial and follow-up cancer antigen-125 levels were higher in the low-GDP group. Multivariable analysis showed that low-GDP was associated with a higher cell score 3-free survival rate. The present study shows that a low-GDP solution may be associated with preserving the mesothelial cell and peritoneal membrane characteristics.

The high prevalence of sleep disorders highlights the importance of its treatment in hemodialysis patients. Due to complications of hypnotic medications, considering effective nonpharmacological methods to improve sleep quality is important. This study has conducted to determine the effect of a sleep hygiene training program on sleep quality of hemodialysis patients. In a randomized controlled clinical trial, 82 hemodialysis patients were randomly selected and allocated to the intervention (n = 41) and control (n = 41) groups. A 1-month sleep hygiene program was provided to the intervention group within 6 sessions, and the sleep quality was assessed by the Pittsburgh Sleep Quality Index before and after the intervention. The global and components scores were compared between the two groups. The mean global scores and component scores of sleep quality were not significantly different between the two groups before the intervention. The mean global score of sleep quality of the intervention group significantly reduced after sleep hygiene education, as compared to the baseline values. The mean global score of the intervention group was significantly lower than that of the control group after the intervention (intervention, 9.92 ± 3.80 versus control, 13.05 ± 4.28). Also, the mean scores subjective sleep quality, sleep latency, sleep disturbances, and daytime dysfunction were significantly lower in the intervention group. The findings of this study suggest that nursing and physicians team should consider reducing sleep problems of hemodialysis patients by training sleep hygiene.

Screening for hematuria was carried out in 3000 school-age children (6 to14 years old) in Gorgan, Iran, using a fresh morning urine sample. At the initial step, 208 (6.8%) had positive dipstick tests for blood, which decreased to 35 (1.2%) at the second step. Of the 35 children with hematuria, 27 (77.1%) were girls and 8 (22.9%) were boys. Twenty-six children were further evaluated of whom 5 had normal findings, and 7 had hypercalciuria, 13 had nephrolithiasis, and in 1 had a large cystic lesion on ultrasonography, ultimately diagnosed as oncocystoma.

Although renal tubular acidosis (RTA) is a rare complication of systemic lupus erythematosus (SLE), type 4 RTA associated with lupus nephritis is extremely rare. A 20-year-old woman presented with malaise and edema in the lower extremities and face. She had multiple lymphadenopathies. There were 20% eosinophil in blood smear and 32% in bone marrow aspiration. Serology revealed positive antinuclear antibody at 1:1000 titer, positive double-stranded DNA antibodies, and low complements C3 and C4 levels. Urinary sediment was active and urinary protein excretion was 4.8 g/d. The SLE Disease Activity Index score was 23. A high SLE Disease Activity Index scores was proposed as a potential risk factor for type 4 RTA. Type 4 RTA may complicate SLE, and specifically, patients with high SLEDAI scores and lymphadenopathy may pose a high risk. Our patient responded successfully to immunomodulatory therapy.

Sagliker syndrome was introduced in 2004 in patients with end-stage renal disease and severe secondary hyperparathyroidism. This syndrome describes maxillary and mandibular deformities, dental abnormalities, benign soft tissue tumors in mouth, and various kinds of skeletal changes including short stature and fingertip abnormalities. There are a few reports from different regions of the world. The aim of this study is to report 5 cases of the Sagliker syndrome from Iran.

Myelosuppression is the life-threatening adverse effect of methotrexate. Impaired kidney function is a major aggravating factor of methotrexate-induced myelosuppression. In end-stage renal disease patients, methotrexate therapy must be with cautious because the efficacy of removal of methotrexate by means of dialysis is in doubt. In clinical practice, low-dose methotrexate is still used by clinicians in treatment of dialysis patients with immunological disorders. We reported a 61-year-old woman on continued ambulatory peritoneal dialysis who developed pancytopenia with a nadir leukocyte count of 0.03 × 109/L, leading to severe sepsis after 3 doses of methotrexate, 7.5 mg weekly. We highlighted that methotrexate therapy in dialysis patients, even with low doses could impose the risk of myelosuppression, causing a fatal outcome. Alternative medications to methotrexate might be recommended in dialysis patients.