Iranian journal of kidney diseases最新文献

This epidemiological study aimed to identify the primary categories of kidney pathology diagnosis and their prevalence among patients admitted to Shahid Labbafinezhad Teaching Hospital. We included 1006 kidney biopsy findings from 2019 to 2022. The majority of kidney patients (78%) were between the ages of 20 and 60 years. Nephrotic syndrome made up 62% of the patient population. The findings revealed that primary glomerulonephritis, secondary glomerulonephritis, tubular/interstitial nephritis, end-stage kidney disease, and unclassified cases accounted for 63%, 17%, 12%, 6%, and 2% of kidney disease cases, respectively. The inclusion of a large number of patients from various regions across the country, combined with the expertise of the laboratory staff, underscores the reliability and significance of the results obtained in this study.

Introduction: Ischemia followed by reperfusion in organ transplantations can lead to ischemia-reperfusion (I-R) injury, which is associated with oxidative stress and inflammatory responses. Alpha-pinene is an organic terpene with well-known antioxidant, anti-inflammatory, and anti-apoptotic properties. This study examines the preventive effects of alpha-pinene against renal I-R-induced kidney dysfunction, oxidative and inflammatory status, apoptosis, and histopathology changes.

Methods: Forty-two adult male Wistar rats weighting 200-250 gr were divided into six groups (n = 7): Control, Right Nephrectomy, Ischemia-Reperfusion (45 min ischemia and 24 h reperfusion), and I-R + three different doses of alpha-pinene (2.5, 5, and 10 mg/kg) 24 hours and just before induction of ischemia through gavage. After 24 hours, urine, serum, and the remaining kidney were collected for biochemical and tissue analysis.

Results: Renal I-R caused kidney damage indicated by a significant decrease in creatinine clearance, induction of oxidative stress, increased inflammatory cytokines, and histopathological injuries. Alpha-pinene significantly improved the damage by restoring the changes toward the control group. Alpha-pinene, in the effective dose (2.5 mg/kg), reduced the levels of Bax, Bcl-2, TNF-α, and IL1β and contributed to regenerating tissue damage following renal I-R.

Conclusions: Aalpha-pinene has been able to reduce the complications due to its antioxidant, anti-inflammatory, and anti-apoptotic properties. It is suggested that it can be used as a pretreatment in reducing renal complications in renal transplantation.

Introduction: Acute kidney injury (AKI) is a frequent complication after hematopoietic stem cell transplantation (HSCT), with reported incidences ranging from 20-70% within the first 100 days post-transplant. AKI can adversely impact outcomes and survival in this patient population.

Methods: This retrospective study evaluated 110 pediatric patients who underwent HSCT at Mofid Children's Hospital, affiliated with Shahid Beheshti University of Medical Sciences, Tehran, Iran, between 2016-2021. AKI was defined and staged according to the criteria for Kidney Disease Improving Global Outcomes (KDIGO).

Results: The cohort comprised 68 (61.8%) males and 42 (38.2%) females, with a mean age of 6.4 ± 4.1 years. Underlying disorders were malignant in 64 (58.1%) and non-malignant in 46 (41.9%) patients. Among the cohort, 84 (76.3%) patients underwent allogeneic HSCT, while 26 (23.7%) received autologous HSCT. Myeloablative and reduced-intensity conditioning regimens were used in 77 (70%) and 33 (30%) patients, respectively. AKI developed in 53 (48%) patients within 100 days post-transplant, with incidences of 38%, 40%, and 22% for stages 1, 2, and 3 AKI, respectively. AKI incidence was higher in allogeneic HSCT (52%) compared to autologous HSCT (17%; P = 0.023). Younger age (P = 0.033) and non-malignant disorders (P = 0.033) were associated with increased AKI risk. At the end of the study, 77 (70%) patients were alive, and 33 (30%) had deceased, with a significant positive correlation between AKI stage and mortality (P = 0.004).

Conclusion: This study highlights the high prevalence of AKI among pediatric HSCT recipients, particularly those undergoing allogeneic HSCT, at a younger age, and with non-malignant disorders. Regular post-transplant renal monitoring may improve survival in this population.

Introduction: Autophagy related genes (ARGs) may play important roles in various biological processes involving kidney transplantation (KT); however, their expression characteristics are rarely used to study the relationship between autophagy and prognosis in KT patients. This study aims to construct a new autophagy related gene feature based on high-throughput sequencing datasets.

Methods: Differentially expressed ARGs (DEARGs) were identified in KT patients based on the Gene Expression Omnibus (GEO) database. Gene Ontology (GO)and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed to explore potential biological and pathological functions of DEARGs. Univariate and Lasso Cox regression analyses identified survival-related DEARGs and established a prognostic gene signature whose performance was evaluated by Kaplan-Meier curve and receiver operating characteristic (ROC). Moreover, the prognostic value of the gene signature was further validated in 48 KT patients from the GSE21374 dataset.  Results. A total of 28 common DEARGs were identified between rejection and non-rejection samples in 3 datasets, including GSE21374, GSE36059, and GSE48581. GO and KEGG enrichment analyses showed that DEARGs were mainly involved in regulating apoptotic processes. In addition, we identified and validated 7 DEARGs (CASP1, CASP3, FKBP1A, RAB11A, NFKB1, RGS19, and CCL2) as the prognostic signatures. The Kaplan-Meier (K-M) analysis showed that the survival rate of the high-risk patients was significantly lower than that of the low-risk patients.

Conclusion: The effectiveness of autophagy related features was validated by using 48 KT patients in the GSE21374 dataset, and establishing and confirming a new ARG signal with independent survival prognostic value for KT patients.

Introduction: Protein-energy wasting (PEW) is highly prevalent among patients undergoing peritoneal dialysis (PD), and it has been proposed that oxidative stress (OS) may contribute to its pathogenesis. This study was an attempt to determine the association between the presence of PEW and OS levels in PD patients.

Methods: This analytical cross-sectional study involved 62 clinically stable PD patients aged ≥ 18 years, between September 2017 and July 2018. PEW was assessed using PEW definition criteria, 7-point Subjective Global Assessment (SGA), and Malnutrition-Inflammation Score (MIS). Redox state was evaluated through oxidants (lipoperoxides, 8-Isoprostane, nitric oxide), antioxidants (superoxide dismutase, catalase, glutathione peroxidase-GPx, total antioxidant capacity), and oxidative DNA damage [8-hydroxy2'-deoxyguanosine-8-OHdG, 8-Oxoguanine-DNA-N-Glycosylase-1(8-OHdG)].

Results: Among study participants, 38 (61.2%) were males and 24 (38.8%) were females; 22 (35.4%) had diabetes mellitus [males 15 (68.1%) and females 7 (31.8%)]. The average PD duration was 11 (4-27) months, body mass index: 23.5 ± 4.1 kg/m2, energy intake: 1138.4 ± 394.2 kcal/day, and protein intake: 50.2 ± 18.5 g/day. Prevalence of PEW varied based on the assessment method used (50-88.7%). Plasma 8-OHdG levels were higher in patients with PEW evaluated by MIS (0.1 [0.1-56.4] vs. 1.8 [0.1-74.7] ng/mL, P = .028), while GPx activity was lower in the presence of PEW as measured by MIS (3.6 [3.1-7.6] vs. 2.8 [1.2-10] nmol/min/mL, P = .021). No significant differences were observed between PEW markers and remaining OS levels.

Conclusions: In PD patients with PEW, assessed by MIS, 8-OHdG was significantly increased, while GPx activity was significantly low.

Introduction: To evaluate the impact of TACI fusion protein (TACI-Ig) on IgA nephropathy (IgAN) in rats, and to explore its mechanism and relationship with TLR4/MyD88/NF-κB pathway.

Method: Sprague Dawley(SD)rats were divided into six groups: control, model, TACI-Ig low dose (TACI-Ig-L), medium dose (TACI-Ig-M), high dose (TACI-Ig-H), and prednisone acetate (PAT) group. The control group and model group received physiological saline injections, while the TACI-Ig groups were administered doses of 7.18, 14.36, and 28.72 mg/kg of TACI-Ig, respectively. PAT group was pretreated with prednisone acetate. After 8 weeks, kidney weight/body weight ratios, 24-hour urine protein (24 h UP), serum creatinine (SCr), and blood urea nitrogen (BUN) levels were measured. Additionally, concentrations of B cell activating factor (BAFF), APRIL, and Gd-IgA1 were evaluated by using ELISA. Pathological changes in kidney tissues were scored, and TLR4, MyD88, NF-κB expression levels were detected through western blot (WB) and RT-qPCR.  Results. Renal function assessments showed that the IgAN model group exhibited increased in 24 h UP, SCr, BUN, and elevated serum levels of BAFF, APRIL, Gd-IgA1, alongside higher TLR4/MyD88/NF-κB protein expression. TACI-Ig treatment significantly reduced proteinuria, SCr, BUN, levels of BAFF, APRIL, and Gd-IgA1 in IgAN rats. Pathologically, TACI-Ig ameliorated glomerular mesangial deposition and fibrosis. It also inhibited TLR4/MyD88/NF-κB protein expression, demonstrating anti-inflammatory and immune regulatory effects.

Conclusions: TACI-Ig mitigates renal injury in IgAN rats by reducing inflammatory infiltration and IgA deposition and suppressing the pathway of TLR4/MyD88/NF-κB, offering data for developing effective treatments for IgAN.

Introduction: This study aimed to analyze the correlation between blood pressure variability (BPV), crystalloid osmotic pressure, and cardiovascular events (CEs) in patients undergoing maintenance hemodialysis (MHD).

Methods: This retrospective analysis was conducted on 71 patients with end-stage kidney disease who underwent hemodialysis at Beilun District People's Hospital from September 2021 to September 2022. The patients were divided into two groups based on the occurrence of CEs: a cardiovascular event group and a non-cardiovascular event group.

Results: The 71 patients were divided into two groups based on the occurrence of CEs: the CEs group (25 patients who experienced CEs) and the non-CEs group (46 patients who did not experience CEs). The CEs group had significantly higher levels of crystalloid osmotic pressure, standard deviation of systolic BP (SBP-SD), coefficient of variation of SBP (SBP-CV), SD of diastolic BP (DBP-SD), and DBP-CV (P < .05). Multivariate logistic regression analysis identified crystalloid osmotic pressure, SBP-CV, and DBP-CV as independent risk factors for CEs. The ROC curve analysis indicated that the combined predictive value of crystalloid osmotic pressure, SBP-CV, and DBP-CV was significant, with an area under the curve (AUC) of 0.963.

Conclusion: Elevated crystalloid osmotic pressure, SBP-CV, and DBP-CV are critical risk factors with strong predictive value for predicting CEs in MHD patients.

Introduction: To explore the construction of a diagnostic prediction model of diabetic nephropathy (DN) in type 2 diabetic patients for prognostic risk prediction and observe the therapeutic effect of Epalrestat combined with Dapagliflozin on DN.

Methods: The study consisted of two phases, phase I: A retrospective analysis was conducted on the case information and clinical treatment related data of a total of 460 patients who underwent kidney biopsy from June 2018 to June 2021. They were randomly divided into validation queue and training queue. The predictive factors of the diagnostic prediction model were obtained through multivariate logistic regression.

Phase ii: An interventional study of 94 patients with DN admitted between January 2022 and August 2023 was conducted, and they were randomized into a control group (n = 47) receiving Dapagliflozin and a research group (n = 47) receiving Epalrestat combined with Dapagliflozin. The glucose metabolism, renal function, and treatment safety of the two groups before and after treatment were compared. In addition, the adverse reactions during the treatment of the two groups were counted.

Results: In the phase I of the study, the DN risk model established showed a good performance in the diagnosis and risk assessment of patients with DN and could provide certain reference opinions for future clinical practice. In the phase II of the study, the research group showed better glucose metabolism and renal function than the control group after treatment (P < .05), but no statistical difference was identified between groups in the incidence of adverse reactions (P > .05).  Conclusion. Epalrestat combined with Dapagliflozin is significantly effective in the treatment of DN, which can effectively improve glucose metabolism and renal function in DN patients.

Since the beginning of the COVID-19 pandemic, vaccination has been crucial in reducing deaths and hospitalizations. However, vaccination may trigger autoimmune responses. We present the first case of new-onset systemic lupus erythematosus in a 12-year-old girl, three weeks after receiving the first dose of Sinopharm BIBP COVID-19 vaccine. Complications of COVID-19 vaccines are typically mild. There have been reports of a potential association between the vaccines and autoimmune disorders. However, severe events are rare. Vaccination for COVID-19 is recommended even for those with a genetic predisposition to autoimmune disease, as the advantages of preventing COVID-19 outweigh the potential risks of acquiring autoimmune diseases.