Nephro-Urology Monthly
Volume:6 Issue: 1, Jan 2014

Adiponectin (ADPN) is an important anti-inflammatory marker with anti-atherogenic effects. However, its role in patients with chronic kidney disease (CKD) should be determined.. The aim of this study was to determine the relationship between plasma adiponectin level with some inflammatory and metabolic markers in CKD patients..Patients and In this case-control study, we measured plasma ADPN level in 42 CKD patients and 46 healthy persons with the same age and sex as control group. Then, we investigated the association between plasma ADPN level with some inflammatory and metabolic determinants in CKD patients.. Plasma ADPN level was significantly higher in CKD patients than control group (P = 0.04). It was directly correlated with HDL-cholesterol (r = 0.599, P < 0.001) and serum creatinine levels (r = 0.675, P < 0.001) and inversely correlated with glomerular filtration rate (GFR) (r = -0.570, P < 0.001), body mass index (BMI) (r = -0.318, P = 0.04), C-reactive protein (CRP) (r = -0.548, P < 0.001) and fasting blood sugar (FBS) (r = -0.640, P < 0.001) in CKD patients.. These findings suggested that plasma ADPN level is inversely associated with GFR and directly correlate with HDL-cholesterol and inversely with some, but not all metabolic factors of CKD patients who were not undergone dialysis..

Diabetic nephropathy is the most important cause of end stage renal disease (ESRD). Aldosterone is involved in renal damage through induction of fibrosis, inflammation and necrosis in the kidney tissue. Previous studies have demonstrated that the combination of angiotensin receptor blocker (ARB) and spironolactone (an anti-aldosterone drug) are efficient for albuminuria reduction.. This study was designed to evaluate the effect of spironolactone alone on diabetic nephropathy..Patients and In this double blind randomized clinical trial, 60 type II diabetic patients with microalbuminuria were enrolled. They were divided into two groups: case group (spironolactone 25 mg and placebo, 30 cases) and control (spironolactone 25 mg plus losartan 25 mg, 30 cases). The treatment success rate (more than 50% reduction in microalbuminuria) was compared between the two groups.. After three months, successful treatment was seen in 70% (95% CI: 52 - 83) and 83.3% (CI 95%: 66 - 93) of case and control groups, respectively (P = 0.4). Mean ± SD of serum potassium levels after three months in case and control groups were 4.56 ± 0.38 and 4.39 ± 0.34 mEq/L, respectively (P = 0.08). Mean ± SD of systolic blood pressures in case and control groups were 129.67 ± 9.4 and 130.97 ± 9.4 mmHg, respectively (P = 0.6). Mean ± SD of serum creatinine levels at the end of the study were 0.95 ± 0.15 in case and 0.90 ± 0.22 mg/dL in control group (P = 0.4).. Spironolactone alone is as effective as the combination of spironolactone and losartan on albuminuria reduction in type 2 diabetic patients and can be used alone as an effective drug for diabetic nephropathy..

Infective endocarditis (IE) is a serious complication in immunosuppressive patients that has adverse effects.. The aim of this study was to define the characteristics, outcomes, and correlating factors of mortality in renal transplant recipients.. Patients and Infective endocarditis was diagnosed in 22 patients from three renal transplant centers in Iran between 2000 and 2010. Modified Duke criteria were applied to confirm the diagnosis.. Twenty-two renal transplant patients with IE were evaluated. Blood culture results were positive in 81%. Enteroccous and group D non-enterococcal were the causative microorganisms in 31% and 25% of patients, respectively. In-hospital and 12-month mortality was 41% and the mortality rate was higher in older patients in comparison to younger patients. Overall, the rates of one-year disease-free patient and graft survival were 49% and 88%, respectively.. Despite the availability of different and potent antibiotics, the mortality caused by IE remains considerably high. These patients are significantly prone to endovascular infections that affect the mortality and survival..

Cadmium (Cd) is known to cause various disorders in the testis. The general population may be exposed to Cd through ingestion of food and drinking water, inhalation of particulates from ambient air, tobacco smoke and ingestion of contaminated soil and dust. Saffron (Crocus sativus L.) is widely used as a food flavour, and has well known medicinal effects.. The aim of this study was to determine the effects of saffron on the results of semen parameters (sperm concentration, motility and viability in cauda of epididymis) in rats exposed to cadmium..Thirty Wistar male rats were divided into four groups. Cadmium chloride (1 mg/kg body weight) was injected intraperitoneally during 16 days at intervals of 48 hours between subsequent treatments. Crocus sativus L. (100 mg/kg b.w., IP) was pretreated in both control and cadmium-injected rats. Both control and cadmium-injected rats were pretreated with Crocus sativus L. (100 mg/kg b.w., IP). The animals were killed and their sperm count, motility, and vitality were evaluated.. Sperm parameters did not differ significantly between control and sham groups. Following contamination with cadmium, sperm count, motility and vitality were significantly decreased in comparison to control group (P < 0.05). In pretreated (saffron) group, the sperm parameters improved significantly in comparison with cadmium group (P ≤ 0.05). A significant decrease in sperm motility was observed in Cd-treated rats compared to the control rats. However, no significant changes were recorded by comparison of the control and saffron treated groups except for the sperm motility parameter.. Saffron, as an antioxidant, is positively effective on sperm parameters in rats exposed with cadmium..

Tamsulosin is an α-1A-specific blocker which induces selective relaxation of ureteral smooth muscle with subsequent inhibition of ureteral spasms and dilatation of the ureteral lumen and facilitates stone expelling.. In this study we aimed to assess the efficacy of tamsulosin for improving the success rate of ureteroscopic lithotripsy (URS) for lower ureteral stones..Patients and In a prospective study by a randomized controlled clinical trial, which was performed from June 2008 to December 2010, we enrolled one hundred and forty-two subjects and eventually 102 patients completed the clinical trial. All the patients underwent ureteroscopic lithotripsy with the pneumatic wolf lithotripsy. The patients were randomly divided into 2 groups: the study group including 52 patients, received tamsulosin with our traditional treatment (hydration and analgesic when required), and the control group with 50 patients who received placebo with traditional treatment. The number of colic episodes, lower urinary tract symptoms, analgesic dosage, and days of spontaneous passage of the stones through the ureter were recorded in a diary after lithotripsy.. The results showed that tamsulosin treatment group had low expulsion time (P = 0.011), low urinary tract symptoms, least analgesic needs and low adverse effects, all with statistically significant differences comparable with the control group (P < 0.05).. Administration of α-1A-specific blocker reduced analgesic dosage and colic episodes and rate of adverse effects after ureteroscopic lithotripsy of lower ureteral stones and decreased gravel expulsion time after URSL..

Chronic inflammation is the most important cause of cardiovascular disease in patients undergoing hemodialysis, and vitamin C as a major antioxidant which could be effective to suppress inflammation..

This study was performed to evaluate the effect of vitamin C supplementation on C-reactive protein levels in patients undergoing hemodialysis..Patients and

This randomized, placebo-controlled and double-blind trial was conducted on 151 patients on hemodialysis who were divided randomly by lottery method to three identical groups. In the intervention group, 250 mg of vitamin C was injected intravenously immediately at the end of each hemodialysis session three times a week for 8 weeks in a row. In the control group 1, same term of placebo saline was injected, and in the control group 2, no intervention was performed..

A total of 86 (61%) male and 55 female patients with mean hemodialysis duration of 39.74 ± 45.5 months, and a mean age of 61.36 ± 11.46 years-old, participated in this study. Hypertension and diabetes were the most common underlying diseases (79.4%). Median baseline CRP in the intervention, control 1 and control 2 groups were 16.8, 17.8, and 19.4 mg/L respectively. After 2 months, median CRP reduced significantly in the vitamin C group to 10.7 (P = 0.04) vs. 22.6, and 30.6 mg/L in control groups..

Our findings demonstrated that vitamin C supplementation modifies the levels of CRP in patients on hemodialysis..

Hypovitaminosis D (serum 25-OHD < 30 ng/mL) is common in patients with chronic kidney disease (CKD). Vitamin D is believed to involve in the regulation of renin-angiotensin system and may be renoprotective..To compare the effects of calcium with or without calcitriol on renal function in patients with CKD..Patients and A prospective randomized trial was performed involving patients with stages 2-4 CKD and hypovitaminosis D. Baseline demographics data were taken at baseline. Patients were randomized equally into oral calcitriol plus calcium carbonate (calcitriol group) or calcium carbonate alone (non-calcitriol group). Serum levels of 25-hydroxyvitamin D (25-OHD), 1,25-dihydroxyvitamin D3 (1,25-(OH)2D), creatinine, calcium and urine protein creatinine index (uPCI) were measured at 6 and 12 weeks.. Fifty (21 Female: 29 Male) patients with CKD with a median age of 53 (22-65) years were recruited. Their median MDRD eGFR (modification of diet in renal disease, estimation of glomerular filtration rate) was 36.0 (15-89) mL/min/1.73 m2 with the CKD stage 2 (n = 8, 16%), stage 3 (n = 29, 58%), and stage 4 (n = 13, 26%) respectively. In both study groups serum 25-OHD levels were increased at 12 weeks (P = 0.001), in contrast to serum 1,25-(OH)2D levels which remained unchanged (P > 0.05), serum creatinine and uPCI were also remained unchanged until the end of study (P > 0.05 each). Patients with diabetes had higher serum creatinine (P = 0.01) and lower serum 1,25-(OH)2D (P = 0.02) at baseline. Regardless of the diabetics status, the serum 25-OHD was increased, and 1,25-(OH)2D remained unchanged at 12 weeks in both study groups. At 12 weeks, serum creatinine was decreased in patients with diabetes in the noncalcitriol group (P = 0.03) compared to stabilization of creatinine in the calcitriol group (P > 0.05). Serum calcium was increased, though it was still within the normal range in the calcitriol group (P < 0.001); whereas, in the noncalcitriol group, there was an initial reduction but increased back to baseline (P = 0.007). Urine PCI remained unchanged in both groups.. We have demonstrated that calcitriol supplementation did not offer any additional benefit to reduce 25-OHD and 1,25-(OH)2D levels over calcium carbonate alone in patients with CKD in this short term study. Overall renal function remained unchanged. However, we found that calcitriol at 0.5 mg daily plus calcium carbonate 500 mg daily could be reno-protective in diabetic nephropathy regardless of their serum 25-OHD levels..

Vesico-ureteral reflux (VUR) is presented in approximately %1 of children and is associated with an increased risk of pyelonephritis and renal scarring. Despite its prevalence and morbidity, many aspects of VUR diagnosis and treatment are controversial. We objectively assessed the published data; the data base for many current diagnoses and treatment patterns of VUR is limited. Recent studies have focused on developed determination of VUR-related renal morbidity, improved stratification tools that children would benefit most from which VUR treatment option, and improved reporting of the long-term outcomes of VUR treatments in children who are at risk for VUR. In this review, the advances in the diagnosis and treatment of VUR will be accompanied by the current guidelines..

To improve patient survival after a renal transplant, it is important to detect which variables affect it.. This study aimed to assess the effect of renal allograft failure on patient survival..Patients and This retrospective cohort study included 405 renal transplant patients from Kerman University of Medical Sciences hospital, Kerman, Iran from 2004 to 2010. Kaplan-Meier method was used to estimate survival rates of patients, and time-dependent Cox regression was used to examine the effect of allograft failure on patient survival.. During 4.06 years (median) of follow-up 28 (6.9%) patients died and 20 (71.4%) of dead patients had allograft failure. Survival rate of patients with allograft failure at 1-, 3-, 5-, and 7-year were 0.98, 0.8, 0.53, and 0.53, respectively; in patients with allograft function these values were 0.99, 0.98, 0.97, and 0.96, respectively. The unadjusted death rate was 0.5 per 100 patient years for the maintained allograft function, which increased to 9 per 100 patient years for patients following allograft failure. In fully adjusted model the risk of death increased in patients with allograft failure (HR = 2.09; 95% CI: 1.56-2.81), pretransplant diabetes (HR = 2.81; 95% CI: 1.2-6.7), patients with BMI ≥ 25 (vs. 18.5 ≤ BMI < 25) (HR = 3.56; 95% CI: 1.09-11.6). With an increase in recipient age this risk increased (HR = 1.04 per year increase; 95% CI: 1.01-6.7). Receiving a living kidney transplant decreased this risk (HR = 0.52; 95% CI: 0.39-0.69).. An increase in recipient age and BMI, affliction with diabetes, allograft failure, and receiving deceased kidney transplant increased the risk of death..

This is to report the case of a huge vaginal stone, and bladder calculi in a 26-year-old woman with previous operation of bladder exstrophy. It seems that the vaginal stone was secondary to the remaining wire used in her previous reconstructive surgery for pelvic closure 20 years ago and now surgery is performed to remove the vaginal and bladder stones..

Significant impairment in health-related quality of life (HRQOL) among dialysis patients could be partly explained by some co-morbid disorders, such as chronic kidney disease-mineral and bone disorder (CKD-MBD). Also disturbance in calcium and phosphorus metabolism would increase mortality and morbidity. Therefore, further efforts to treat these abnormalities may improve the survival.. We designed a large multicenter population-based study in Iran to describe and assess the relation between HRQOL, hospitalization, and bone metabolism markers..Patients and We enrolled a total of 5820 dialysis patients from 132 dialysis centers in different parts of the country whom were volunteers to cooperate between October 2010 and August 2011. The Iranian adapted version of the Kidney disease quality of life-short form (KDQOL-SFTM) version 1.3 questionnaire was used to assess the health related quality of life. The clinical and demographic characteristics were gathered from patients’ data files.. The mean (SD) age of patients was 54.88 (16.36) years, and the range was 2 to 99 years. Of all patients, 43.1% were female. The scores of kidney disease component summary (KDCS), physical component summary, mental component summary, and total quality of life were significantly higher in the lower quartile of corrected serum calcium and higher quartile of serum parathyroid hormone (PTH) levels (P < 0.05). In a regression analysis of multilevel data, while corrected serum calcium level was associated with total KDCS and short form health survey (SF-36) scores after adjusting for other variables, hospitalization was directly correlated with serum phosphorus level and had reverse correlation with dialysis duration and quality of life.. In the current study, quality of life was correlated with serum calcium level, calcium-phosphate product, and serum PTH level, while hospitalization was correlated only with serum phosphorus level. However, quality of life was inversely correlated with hospitalization..

Hypertension (HTN) is the most commonly encountered systemic disease in general population. Nutrient canals contain blood vessels and nerves that mostly appear in the anterior mandibular region. Nutrient canals are not detected in radiographs of all patients, and their normalcy is controversial by many investigators.. The present study investigated the correlation between the appearance of nutrient canals and hypertension as a potential clue to diagnose patients with hypertension..Patients and Thirty two patients with HTN and 32 normotensive subjects were selected. Periapical radiographs were taken from mandibular anterior cuspid-central incisor region since nutrient canals are commonly observed in this area. Data was analyzed by SPSS software with Chi-square and Fisher tests.. The incidence of nutrient canals was 37.5% in patients with hypertension and 53.1% in the normotensive subjects, but this difference was not statistically significant (P = 0.209). We did not find any association between duration of hypertension (P = 0.292) or controlled hypertension (P = 0.144), and the presence of nutrient canals. The mean of subject age with nutrient canal was more than those without nutrient canals, and this difference was statistically significant in normotensive patients.. This study revealed that there was no significant association between mandibular anterior nutrient canals and hypertension..