Iranian journal of kidney diseases最新文献

Introduction: Diabetic nephropathy (DN) is a chronic microvascular complication of diabetes mellitus, leading to end-stage kidney disease and increased mortality. Early detection and treatment are essential to prevent DN. This study aims to develop a diagnostic prediction model for early DN.  Methods. This retrospective analysis study was conducted on 205 patients with type 2 diabetes mellitus (T2DM) treated between September 2019 and September 2022. Patients with stage A1 albumin-to-creatinine ratio (ACR) (< 30 mg/g) were categorized as the simple diabetes mellitus group (n = 134), and those with ACR 30-300 mg/g at stage A2 were classified as the early diabetic nephropathy group (n = 71). Relevant ultrasound parameters and hematological indices were selected through univariate and multivariate screenings. A nomogram model was constructed based on the results of multi-factor screening. Internal validation was performed by using Bootstrap methods with 1000 repetitions, receiver operating characteristic (ROC) curve analysis evaluated model differentiation, calibration curves verified model consistency, and decision curve analysis assessed clinical utility.  Results. Multivariate logistic regression identified renal artery resistance index (RI), renal cortex shear wave velocity (SWV), Cystatin C (CysC), Retinol-binding protein (RBP), and Glycated Hemoglobin (HbA1C) as significant factors for early DN (all P < .05). The nomogram model showed good differentiation and consistency and has high clinical value and practicality in predicting DN.

Conclusion: The prediction model for early DN, based on conventional ultrasound parameters and hematological indices, demonstrates good prediction efficiency and clinical practicability.

Introduction: Autosomal Dominant Polycystic kidney disease (ADPKD) is defined as one of the most common genetic disorders and the cause of kidney failure or end-stage kidney disease (ESKD). Several studies have shown that renin-angiotensin system has an important role in pathogenesis of ADPKD. The aim of this study was to examine the association between the angiotensin converting enzyme (ACE) gene Deletion/Deletion (D/D) polymorphism and risk of ADPKD among Iranian patients from west Azerbaijan province of Iran.

Methods: This case-control study was conducted on 40 patients and 72 controls. Genetic polymorphism of the ACE gene was determined using polymerase chain reaction (PCR) and electrophoresis.

Result: The frequency (frequency%) of ACE gene I/I, I/D, D/D genotypes were 5 (12.5%), 12 (30%), 23 (57.5%) in cases and 16 (22.22%), 30 (41.67%), 26 (36.11%) in controls, respectively. The frequency (frequency%) of ACE gene I and D alleles were 22 (27.5%) and 58 (72.5%) in cases and, 62 (43.06%) and 82 (56.94%) in controls, respectively. Statistical analysis indicated that there were significant differences among the cases and controls regarding ACE gene D/D genotypes (P = .028). The ACE gene D/D genotype was associated with increased ADPKD susceptibility with an OR of 2.39, (95%) CI =  (1.09-5.28), and P = .028. But in the case of ACE gene, I/I and I/D genotypes, there were no statistically significant differences between cases and controls (P > .05). Considering allelic comparison, the ACE gene D allele was associated with ADPKD susceptibility with an OR of 1.99, (95%) CI =  (1.1-3.6), and P = .021.

Conclusion: Our findings suggest that ACE gene D/D genotype was associated with ADPKD.

Introduction: Th is study was conducted to explore the role of OIP5-AS1 in a fibrosis cell model through its interaction with miR-181a-5p.

Methods: An in-vitro fibrosis model was established by inducing human renal tubular epithelial cells (HK2) with TGF-β1. The expression levels of OIP5-AS1 and miR-181a-5p in the control (Normal) and model (TGF-β1) groups were measured using Quantitative Real-time Polymerase Chain Reaction (qPCR).. qPCR and  Western Blot  (WB) were used to detect the expression of genes and proteins related to fibrosis and EMT in the two groups of cells. Subsequently, The effect of OIP5-AS1 on TGF-β1-induced fibrosis in HK2 cells was investigated by assessing cell proliferation using the CCK-8 assay and analyzing the expression of fibrosis- and EMT-related proteins through WB.. The targeting relationship between OIP5-AS1 and miR-181a-5p, as well as the influence of OIP5-AS1 on miR-181a-5p expression, was investigated using a dual-luciferase reporter assay. Subsequently, the impact of miR-181a-5p upregulation on the proliferation of TGF-β1-induced HK2 cells was examined through a CCK-8 assay.

Results: The study found that TGF-β1 treatment upregulated OIP5-AS1, α-SMA, Col-IV, and FN in HK2 cells while downregulating miR-181a-5p and E-cadherin. OIP5-AS1 downregulation promoted cell proliferation and inhibited fibrosis-related proteins. MiR-181a-5p was identified as a direct target of OIP5-AS1, and its upregulation enhanced cell proliferation. Conclusion . The suppression of OIP5-AS1 attenuates TGF-β1-induced fibrosis in HK2 cells through the regulation of miR-181a-5p.

Introduction: Continuous renal replacement therapy (CRRT) is a recommended dialysis modality for hemodynamically unstable and critically ill patients with kidney failure. This study aimed to evaluate the effect of variations in serum phosphate levels based on the dialysate used during CRRT and to determine the impact of prognosis and mortality of patients with using dialysate solutions with diverse electrolyte compositions.

Methods: We retrospectively analyzed 117 patients' records, treated with intensive CRRT, comprising 70 patients treated with Phoxilium®, and 47 patients treated with MultiBic®.

Results: After 72 hours of CRRT, the Phoxilium and non-Phoxilium groups exhibited significantly different serum calcium, bicarbonate, and phosphate levels, as determined by an independent-samples t-test. (P < .05). The Kaplan-Meier analysis revealed no significant difference in survival rates between the two groups, demonstrating that the variation in serum phosphate level after 72h of CRRT did not significantly influence survival outcomes. (P = .581). The difference in serum phosphate levels after 72h of CRRT might affect respiratory muscles; however, although cumulative survival exhibited a stepwise decrease with longer mechanical ventilation duration, the two groups did not show significant difference in survival (P = .819). The incidence of hypophosphatemia was significantly lower in the group where CRRT was performed with Phoxilium dialysate containing phosphate compared to the group where CRRT was performed with non-Phoxilium dialysate, and severe hypophosphatemia did not occur. There were no significant associations between hypophosphatemia, mortality, and duration of mechanical ventilation.

Conclusion: Selecting Phoxilium as a dialysate for CRRT should be considered to correct severe hypophosphatemia, prevent complications, and improve prognosis.

Tumor lysis syndrome (TLS) is a well-established potentially fatal condition which is considered an oncologic emergency. TLS typically develops from the rapid lysis of neoplastic cells after the commencement of cytotoxic treatment in patients with some kinds of lymphomas, especially the Burkitt variant, and acute lymphoblastic leukemia. Spontaneous TLS (STLS), a variant of TLS occurring in the absence of chemotherapy or radiation therapy, has been observed in non-Hodgkin lymphoma and acute leukemia, and rarely in solid neoplasms. In this paper, we present a 62-year-old woman with STLS, secondary to metastatic breast cancer. Unfortunately, she died because of complications of acute kidney injury, especially severe metabolic acidosis that was refractory to hemodialysis. Although it is infrequent, healthcare professionals should consider STLS as a probable consequence of breast cancer characterized by a high tumor burden and distant metastases.

Introduction: The bioactive components of Astragalus membranaceus and Salvia miltiorrhiza improved cardiac and renal function in chronic heart failure (CHF) and chronic kidney disease (CKD), respectively. However, the common regulating molecular mechanisms remain unclear. The aim of this study was to investigate these mechanisms using bioinformatics, network topology, and molecular dynamics simulation techniques.

Methods: The active components and target sites of A. membranaceus and S. miltiorrhiza were obtained from the Traditional Chinese Medicine Systems Pharmacology database. The targets of CKD and CHF were obtained from various databases for a protein-protein interaction analysis. The Gene Ontology (GO) function and Kyotoencyclopedia of genes and genomes (KEGG) pathway enrichment of intersection targets were analyzed by using the Database for Annotation, Visualization, and Integrated Discovery (DAVID) database. Molecular docking and dynamic simulations were conducted on the core ingredients and targets. The diagnostic efficiency of the key targets was evaluated by using receiver-operating characteristic (ROC) curves.

Results: A total of 70 active ingredients and 158 common targets were found. The top five core targets were AKT1, STAT3, TP53, MAPK1, and RELA. The GO enrichment analysis included apoptosis and oxidative stress. The KEGG pathway enrichment results indicated that the drug pair regulated the AGE-receptor for AGE signaling pathway, fluid shear stress and atherosclerosis, and the IL-17 signaling pathway. Molecular docking and dynamic simulations confirmed that the core ingredients had good affinity and stability with the key targets. The ROC curves confirmed the accuracy of every key target for identifying CKD and CHF and demonstrated that combining them improves diagnosis.

Conclusion: The combination of A. membranaceus and S. miltiorrhiza proved effective for the treatment of CKD and CHF through various components, targets, and mechanisms. Moreover, it may predict the diagnostic value of key targets, providing a reference for clinical diagnostic applications.

Introduction: Antibody-mediated rejection (AMR) is one of the major obstacles to successful kidney transplantation. The T helper cell subset that plays a key role in the activation of B-lymphocytes and antibody production is T follicular helper (Tfh) cell. Therefore, we aimed to compare the percentage of Tfh cells and the serum level of interleukin 21 (IL-21), mainly secreted by this subset, in patients with AMR and stable recipients.

Methods: Peripheral blood samples were taken from 30 patients diagnosed with AMR and 30 stable kidney transplant recipients as well as 10 age- and sex-matched healthy individuals. The percentage of circulating Tfh cells (TCD4+CXCR5+PD1+) and the level of IL-21 were studied by flow cytometry and ELISA techniques, respectively.  Results. The proportion of cTfh cells among circulating TCD4+ cells in AMR patients was markedly elevated compared to the other groups (P < .0001). It was also higher in stable recipients than in healthy controls (P < .0001). The serum level of IL-21 was increased in AMR patients compared to stable recipients (P = .03) and healthy participants (P = .02). In addition, there was a significant negative correlation between cTfh percentage and the estimated glomerular filtration rate (eGFR) in transplanted patients (P = .001). Moreover, the AUC of cTfh cells in AMR diagnosis was 0.83 [95% CI 0.73-0.93 (P < .0001)].

Conclusion: In AMR patients, cTfh cell percentage and IL-21 levels were significantly increased. The significant association between cTfh % and eGFR, with an AUC of 0.83, indicates its potential as a diagnostic and prognostic marker in AMR.

Autosomal dominant polycystic kidney disease (ADPKD), as a widespread inherited cystic kidney disease has a prevalence of ~1/1000 live births. However, there are rare reports of the association of ADPKD with nephrotic range proteinuria such as lupus nephritis (LN). In this study, we report a patient with ADPKD who manifested a sudden increase of urinary protein excretion with positive anti-double stranded DNA and antinuclear antibody tests. Finally, based on percutaneous ultrasound-guided renal biopsy LN was proved. This report advises clinicians to evaluate ADPKD patients periodically and perform complementary clinical and laboratory investigations in cases with unusual presentations such as nephrotic syndrome.

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.