Iranian journal of kidney diseases最新文献

Introduction: Uremic pruritus (UP) is a disturbing symptom in a quite large proportion of hemodialysis (HD) patients. Recent studies have indicated a potential role of interleukin-31 (IL-31) in the pathophysiology of pruritus, and it is becoming a promising therapeutic target for UP. Hemoperfusion (HP) is an extracorporeal technique that has been shown to be effective in absorbing molecules which may be responsible for inducing pruritus. In this study, we conducted this study to explore whether additional HP could enhance the removal of IL-31 in UP patients.  Methods. The study was conducted in two parts. In Part A, the prevalence and intensity of UP were recorded and the basal serum IL-31 level was determined three times a week in HD patients. Patients with detectable serum IL-31 levels in part A were included in Part B. Each patient had two 4-h test sessions: conventional HD or HD plus HP (HDHP). The reduction ratio (RR) of IL-31 from HD and HDHP was compared.  Results. Forty patients completed part A and 40% of them were suffering from UP. Serum IL-31 was detected at significantly higher percentages in UP patients than in non-UP patients (50% vs 4.2%). Serum levels of IL-31 in UP patients were significantly higher than that in non-UP patients (median: 8.35pg/ml vs 7.8pg/ml). Serum IL-31 levels were significantly correlated with pruritus intensity in patients with UP(r = 0.55, P < .05). Eight patients were enrolled and completed part B. The use of combined HD and HP treatment produced a better RR for IL-31 than HD alone (34.26 ± 1.43% vs 15.28 ± 2.11%, P < .01).

Conclusions: IL-31 may play an important role in the pathophysiology of uremic pruritus. The addition of hemoperfusion to conventional hemodialysis provides enhanced removal of IL-31.

Introduction: Continuous Renal Replacement Therapy (CRRT) is commonly used in patients with hemodynamic instability but is associated with potential complications. Understanding these complications can improve CRRT efficiency and patient outcomes.

Methods: This cross-sectional study investigated CRRT complications in patients > 18 years old who underwent CRRT at a tertiary medical center from 2017 to 2022. Data were collected from patient records and the hospital's laboratory system.

Results: A total of 178 patients underwent CRRT for fluid overload (38%) and non-septic acute kidney injury (AKI) (35%). The most common CRRT modalities were hemofiltration (54%) and hemodiafiltration (31%). Among patients, 76% experienced a reduction in platelet count (mean decrease of 40% ± 24). Hemoglobin declined by ≥ 1 g/dL in 58% of patients. Phosphorus decreased in 64.6% of patients (mean reduction of 33%) and potassium decreased in 50% (mean reduction of 18%), but these reductions were not statistically significant (P-values: 0.73 and 0.88). Vasopressors were stopped in 27% of patients, and the dose was reduced in 50.4%. No significant hypothermia, allergic reactions, pneumothorax, hemothorax, or air embolism were reported. The survival rate at hospital discharge was 64% (123 out of 178).

Conclusion: CRRT is a safe and efficient treatment for AKI, with notable reductions in platelet count and vasopressor dependency. However, reductions in phosphorus and potassium were not significant, indicating manageable complications.

Introduction: Immune-complex mediated glomerulonephritis (IC-GN) has a poor prognosis and commonly leads to kidney failure This study reports 20-year experience with the long-term outcomes of 222 Iranian IC-GN patients.

Methods: This single-center historical cohort study was conducted on patients who underwent kidney biopsies from 1998 to 2018 in Hasheminejad Kidney Center (HKC). Initial demographic, clinical, laboratory, and pathology data were extracted from the glomerulonephritis registry of HKC. Follow-up data was obtained by reviewing hospital and outpatient files, as well as phone calls. The primary outcomes were end-stage kidney disease (ESKD) and death, and the secondary outcomes were complete remission, partial remission, and stable chronic kidney disease.

Results: A total of 222 patients, (141 (63.5%) males, 81 (36.5%) females, mean age: 37.76 ± 15.71 years), were diagnosed with IC-GN. The most common causes were IgA nephropathy and lupus nephritis. Among all, 60.2% progressed to ESKD, 15.5% died, 13.1% achieved complete, and 18.5% achieved partial remission. The overall one-, three-, five-, and ten-years kidney survival rates were 52%, 42%, 38%, and 27%, respectively, with a significant difference between the IC-GN subtypes (P < .001). The highest kidney survival rate was found in lupus nephritis. Significant independent predictors of ESKD were the percentage of interstitial fibrosis and tubular atrophy (adjusted hazard ratio (aHR) = 1.022 [95% confidence interval (CI) = 1.012-1.033]), percentage of active crescents (aHR = 4.002 [95% CI = 2.066-7.752]), and initial serum creatinine level (aHR = 1.073 [95% CI = 1.035-1.112]) (P < .001 for all).

Conclusion: There was a significant difference between the long-term survival of IC-GN types. Histopathologic features, and higher initial serum creatinine levels, were important predictors of poor outcome.

Introduction: Activation of the complement system following transplantation may result in allograft rejection. Our study aimed to evaluate the potential relationship between factors affecting kidney transplant success and complement 5 (C5) using bioinformatic tools.

Methods: GenCards and Genemania were used to provide the genetic functional information belonging to the C5 gene, and genomic browsers of STRING, UCSC, KEGG were used to reveal interactions with other genes and various pathways. MiRDB was used to specify the miRNAs that were associated with the C5 gene. The UniProt database was used to determine the tissues that expressed the C5 gene using protein-protein interactions.

Results: In the bioinformatic analyses performed, high levels of C5 gene expression were found in the naiive kidney. Twenty-five genes were found to be strongly associated with C5. Fifty-four miRNAs targeting the C5 gene were specified. The C5 gene was found to be involved in biologic processes such as complement activation (FDR = 6.46e-22), complement binding (FDR = 2.20e-06), cytolysis (FDR = 4.82e-14), regulation of complement activation (FDR = 4.08e-24), positive regulation of vascular endothelial growth factor production (FDR = 0.0430), regulation of macrophage chemotaxis (FDR = 0.0447), activation of the immune response (FDR = 1.26e-13), leukocyte-mediated immunity (FDR = 1.41e-09), innate immune response (FDR = 3.05e-09), allograft rejection (FDR = 2.40e-12), oxidative injury response (FDR = 0.00016), and trigerring of the beginning of the complement cascade (FDR = 0.0244).

Conclusions: The data obtained in this study will be used to guide future experimental investigations in the field of transplantation, and these data will give physicians with insight into allograft status following transplantation.

In October 2024, an Iranian educational nephrology team visited Tajikistan to participate in a continuous medical education (CME) course. This report represents the results of their trip from their perspective.

Introduction: To investigate the effect of continuous renal replacement therapy (CRRT) in patients with severe acute kidney injury (AKI) by using Nafamostat Mesilate (NM).  Methods. Eighty patients with AKI who underwent CRRT from March 2022 to January 2022 were divided into control group (n = 40, treated with unfractionated heparin) and Observation group (n = 40, treated with NM). The duration of the first filter use, the number of filters used 72 hours after treatment, coagulation and renal functions, adverse reactions, bleeding events, length of stay in intensive care unit (ICU) and survival status at 28 days were compared between the two groups.  Results. The observation group used the first filter for a longer period of time than the control group, and after 72 hours of treatment, the number of filters used was less than that of the control group (P < .05); Compared with before treatment, the levels of fibrinogen (FIB) and platelet count (PLT) in the observation group and control group decreased after 48 hours of treatment, while the levels of activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), and international normalized ratio (INR) increased. However, the levels of FIB and PLT in the former group were higher, while the levels of APTT, PT, TT, and INR were lower (P < .05); Compared with before treatment, the levels of creatinine (Scr), urea nitrogen (BUN), and serum cystatin C (CysC) in the observation group and control group decreased after 48 hours of treatment, and the former was even lower (P < .05); the incidence of bleeding events in the observation group was lower than that in the control group, the length of stay in ICU was shorter than that in the control group, and finally the 28-day survival rate was higher than that in the control group (P < .05). The adverse reactions of the two groups were similar (P > .05).

Conclusions: NM can improve the coagulation function and renal function in patients with severe AKI undergoing CRRT, prolong the duration of the filter use, reduce the number of filters used, shorten the length of ICU stay, reduce the incidence of bleeding events, and improve the prognosis.

Introduction: This study was conducted to evaluate the predictive power of the Surgical Apgar Score (SAS) based on surgical blood loss, the lowest intraoperative heart rate and mean arterial pressure in foreseeing short- and long-term effects of radical nephrectomy (RN) on renal function.

Methods: A prospective investigation was conducted on 111 patients who underwent RN for kidney tumors at a tertiary hospital between 2016 and 2019. The SAS and age-adjusted Charlson Comorbidity Index (CCI) scores were calculated in relation to glomerular filtration rates (GFR) changes on postoperative 1st day, 3rd and 12th months.

Results: Patients in higher risk groups, stratified on the basis of SAS, had longer operation times, extended hospital stays, increased bleeding, and higher blood transfusion rates (P < .001).No significant difference existed between preoperative and early postoperative GFR values in SAS-stratified risk groups (P = .802, P = .342, respectively). However, a significant GFR decrease occurred in the high-risk group compared to the moderate and low risk groups at postoperative 3rd (60.79 ± 16.86, 76.22 ± 24.20, 69.80 ± 18.92,respectively) and 12th months (53.57 ± 12.74, 71.61 ± 17.52, 71.86 ± 19.33, respectively)(P = .034, P < .001). CCI scores predicted preoperative GFR in low, moderate, and high-risk groups (111.58 ± 30.91 ml/min, 94.81 ± 22.55 ml/min, and 85.43 ± 32.69 ml/min, respectively)(P = .001), but GFR changes between CCI-defined risk groups were not significant at postoperative 3rd and 12th months (P = .546, P = .481).

Conclusion: A significant correlation was found between SAS estimated during the RN procedure and GFR changes at three and twelve months after surgery. Based on SAS, early kidney-preserving therapies like diet, and avoidance of nephrotoxic agents may be recommended for high-risk patients to prevent prolonged GFR alterations.

Introduction: Acute kidney injury (AKI) is commonly precipitated by sepsis. Continuous veno-venous hemofiltration (CVVHD) is a critical intervention for managing AKI, but further exploration is needed to understand its effects on novel renal injury markers and patient outcomes. The aim of this study is to evaluate the impact of CVVHD on novel renal injury markers and its prognostic significance in individuals suffering from sepsis-related AKI.

Methods: Retrospective analysis was carried out on the medical data of 84 patients with sepsis-induced AKI treated at Baoji High-Tech Hospital from February 2022 to August 2023. We assessed changes in serum biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1) and liver fatty acid-binding protein (L-FABP) pre- and post-CVVHDF treatment, and correlated these changes with the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. Cox regression was utilized to identify independent prognostic factors influencing 28-day survival, from which Kaplan-Meier curves and a prognostic nomogram were derived.

Results: A significant reduction in the serum concentrations of s-NGAL, L-FABP, and KIM-1 was observed following treatment (all P < .001). A positive correlation between these serum biomarkers and APACHE II scores was observed both before and after CVVHDF treatment (all P < .001). According to multivariate Cox regression analysis, coronary heart disease (P = .016), the stage of renal injury (P = .014), APACHE II score (P < .001), and s-NGAL (P < .001) were independent predictors of prognosis for 28-day survival.

Conclusion: CVVHD effectively decreases KIM-1, L-FABP, and NGAL levels, thereby enhancing kidney function in individuals suffering from sepsis-related AKI. Key prognostic indicators for 28-day survival include the presence of coronary artery disease, advanced kidney injury stage, APACHE II score ≥ 26, and NGAL levels ≥ 5.49.

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.