Iranian journal of kidney diseases最新文献

Angiotensin receptor blockers (ARBs) are commonly prescribed in pediatric hypertension because of the fundamental role of the renin-angiotensin-aldosterone system in the pathogenesis of hypertension. We, therefore, aimed to systematically review articles that investigated efficacy and safety of ARB agents in the pediatric population aged over six years. To do so, the databases of Web of Science, PubMed/MEDLINE, and Scopus were searched to conduct a systematic review by using the following keywords: ("angiotensin receptor blocker" OR "valsartan" OR "losartan") AND ("pediatric" OR "children" OR "child") AND ("high blood pressure" OR "hypertension"). Finally, 12 studies were included in our review, and we found that almost all of them supported the effectiveness and tolerability of different ARB agents. Candesartan cilexetil lowered blood pressure (BP), with a 9 mmHg decline in both systolic and diastolic BP, and proteinuria after four months of treatment. Valsartan and Losartan similarly were shown to be effective in lowering BP in a dose-dependent manner. Headache, dizziness, upper respiratory infection, and cough were the most reported side effects. However, almost all reviewed studies indicated that the safety profile was satisfactory. In conclusion, ARBs are beneficial and well-tolerated antihypertensive medications.  DOI: 10.52547/ijkd.7228.

Introductions: Malnutrition-inflammation-atherosclerosis is an independent risk factor and the most significant cause of death in dialysis patients, accounting for about 50% of deaths in the population. Moreover, the high incidence of cardiovascular-induced mortality in patients with end-stage kidney disease cannot be fully attributed to cardiovascular (CVD) risk factors only. Studies suggest that risk factors such as oxidative stress, inflammation, bone disorders, vascular stiffness, and energy protein loss are closely related to CVD and its associated mortality in these patients. Moreover, dietary fat is a crucial factor in CVD. This study focused on determining the relationship between malnutrition-inflammation and fat quality indicators among CKD patients.

Methods: This study was conducted on 121 hemodialysis patients aged 20 to 80 years in a teaching hospital affiliated to Hashminejad kidney center in Tehran, Iran during 2020 to 2021. Data on general characteristics and anthropometric indices were collected. The malnutrition-inflammation score was assessed by using MIS and DMS questionnaires and dietary intake was measured by a 24-hour recall questionnaire.

Results: Out of 121 hemodialysis patients participating in the study, 57.3% were male and 42.7% were female. Anthropometric demographic characteristics showed no significant difference among diverse groups with heart disease (P > .05). There was no significant relationship between malnutrition-inflammation and heart disease indices in hemodialysis patients (P > .05). Furthermore, there was no correlation between the dietary fat quality index and heart disease (P > .05).

Conclusion: In this study, there was no significant relationship between the malnutrition-inflammation index and the dietary fat quality index with cardiac disease in hemodialysis patients. Further studies are needed to have a tangible conclusion.  DOI: 10.52547/ijkd.7280.

Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is a prevalent renal disorder that causes abnormal growth of renal epithelial cells. The excessive expansion of renal epithelial cells can lead to cyst formation that is associated with serious renal complications. The early diagnosis of ADPKD makes the control of the disease somehow attainable. Regarding the diagnostic potential of microRNAs (miRs) as robust clinical biomarkers, the present study aimed to examine the potential of urinary miRs in early diagnosis of ADPKD in asymptomatic patients.

Methods: Urine samples were obtained from 20 asymptomatic ADPKD patients and 20 healthy control individuals and the miR content of the samples was extracted and converted to cDNA for the qRT-PCR experiment. The relative expressions of miR-17, miR-21, miR-143, and miR-223 were evaluated in ADPKD cases and healthy individuals. Serum levels of kidney function markers were also evaluated in the study participants.

Results: The urine samples of patients with ADPKD demonstrated higher levels of miR-17, miR-21, and miR-143 along with a lower miR-223 level compared to the healthy control group.

Conclusion: This study revealed the differential expression of the studied miRs in ADPKD patients. Detection of miRs in urinary samples might provide a useful platform for early diagnosis of ADPKD in asymptomatic patients.  DOI: 10.52547/ijkd.7281.

Introduction: Despite great advances in hemodialysis, complications during dialysis remain in force. Accurate assessment of dry weight is a determining factor in the prevention of hemodialysis complications. This study is designed to evaluate the effect of adjustment of ultrafiltration rate, on hemodialysis complications, based on dry weight calculation, by measuring the pre-dialysis serum sodium.

Methods: In this single-blind clinical trial 50 patients were included. The patients were randomly divided into case and control groups. First, in the intervention group, the blood sodium level was measured before dialysis. Then, the dry weight of the patients was determined, ultrafiltration was adjusted according to the dry weight, and the patients' dialysis program was performed. In the control group, dry weight was determined routinely. Blood pressure, muscle cramps, nausea, and vomiting were recorded in both groups for 3 months.

Results: The results showed a significant difference between the two groups in the rate of postoperative nausea and vomiting (P < .05) and muscle cramps during dialysis (P < .05). There were no significant differences between the two groups in blood pressure drop during dialysis and fatigue after hemodialysis in the first, second, and third months (P > .05).

Conclusion: Accurate assessment of dry weight by the pre-dialysis blood sodium formula, reduces muscle cramps, nausea, and, vomiting.  DOI: 10.52547/ijkd.7170.

Introduction: The prevalence of hyperuricemia shows an increasing trend among kidney transplant recipients. The association between metabolic syndrome and hyperuricemia among the recipients of kidney transplants may consequently lead to reduction in graft survival. In this regard, the present study aimed at comparing the kidney transplant recipients with and without metabolic syndrome in terms of the prevalence of hyperuricemia.

Methods: This cross-sectional study was carried out on kidney transplant recipients who were referred to the Kidney Transplant Clinic of Montaserieh Organ Transplant Hospital, Mashhad University of Medical Sciences, from 2019 to 2020. The serum uric acid, anthropometric data, renal function, glucose levels, and lipid profile of the study participants were evaluated.

Results: According to our findings, higher mean uric acid levels were reported in recipients with metabolic syndrome (6.9 ± 1.51 mg/dL), compared to recipients without metabolic syndrome (6.11 ± 1.47 mg/dL; P < .001). It was also found that 55.6 and 38.5% of the cases with and without metabolic syndrome had hyperuricemia, respectively (P < .05). Additionally, the results showed no significant association between hyperuricemia and the number of metabolic syndrome criteria (P > .05). A comparison between recipients with and without hyperuricemia revealed significantly lower levels of tacrolimus in the hyperuricemia group (P < .05). Regarding serum Tacrolimus levels, no significant difference was found between recipients with and without metabolic syndrome (P > .05). Moreover, there was no significant difference between recipients with and without hyperuricemia (P > .05) or metabolic syndrome (P > .05) in terms of serum cyclosporine level.

Conclusion: The findings of the current study indicate that kidney transplant recipients suffering from metabolic syndrome have higher mean serum levels of uric acid than those without metabolic syndrome.  DOI: 10.52547/ijkd.7141.

Introduction: Glucocorticoids (GCs) are commonly prescribed as immunosuppressive agents after kidney transplantation and their most common non-traumatic adverse effect is Avascular Necrosis (AVN) of the femoral head. In this regard, this study aimed to evaluate the glucocorticoid receptor (GR) polymorphisms among kidney transplant recipients and their potential role as a risk factor for the incidence of AVN.

Methods: In this study, 99 renal transplant recipients were evaluated for the correlations of GR polymorphisms including N363S (rs6195), BclI (rs41423247), ER22/23EK (rs6189/rs6190), and A3669G (rs6198) with AVN after renal transplantation.

Results: Results showed that none of the renal-transplanted patients neither with GC hypersensitive polymorphisms (N363S and BclI) nor with GC-resistant polymorphisms (A3669G and ER22/23EK) developed AVN (P > .05). In addition, the medications of the renal recipients with AVN were significantly different from the nonAVN patients (P < .001).

Conclusion: The study results indicate that the GR polymorphisms have no critical roles in the susceptibility to AVN after renal transplantation. However, further studies to confirm the results are recommended.  DOI: 10.52547/ijkd.7221.

Introduction: Return to work after a kidney transplantation in a previously functioning person is determined by a number of medical and non-medical factors. In this regard, this study was to investigate the factors that influence return to work in kidney transplant recipients.

Methods: This retrospective cohort study was conducted in patients with kidney transplant in the main nephrology center in Tehran (December to April 2022). The primary outcome was the cumulative rate of return to work at 3, 6, and 12 months after transplantation. The secondary outcome was to compare the occupational, individual, and disease-related factors between patients who had returned to work and those who had not.

Results: Among 214 kidney transplant recipients, the overall cumulative rate of return to work after kidney transplantation at 3, 6 months, and 12 months were 44.4%, 63.1% and 69.6%; respectively. According to the univariate analysis, male sex, age less than 40 years, nonphysical jobs, job satisfaction, employer support, partner support, and absence of diabetes mellitus significantly affected the time of return to work (P < .05). According to the multivariate analysis, absence of diabetes mellitus, nonphysical jobs and job satisfaction had greater impact on the time of return to work (P < .05).

Conclusion: The results showed that older age, female gender, having a physical job, the presence of diabetes mellitus, lack of job satisfaction, and employer and partner support are associated with not returning to work in these patients and adjusting factors linked to the work environment and support of colleagues and supervisors might play an important role in improving the general condition of these patients.  DOI: 10.52547/ijkd.7210.

Obesity is a growing problem that causes various metabolic disorders and organ dysfunction. The present systematic review and meta-analysis examined the impact of obesity on the risk of kidney stones. This meta-analysis was designed according to PRISMA guidelines. This extensive search was conducted on June 6, 2022, using relevant keywords in databases including PubMed, Web of Science, EMBASE, and Scopus. The data collected from observational studies were recorded in a datasheet. Odds Ratio (OR) and their 95% confidence intervals (CI) evaluated the overall effect size. The Cochran Q test and the statistic I2 were used to evaluate the heterogeneity of studies. Egger's and Begg's tests assessed potential publication bias. We included 15 observational studies published between 2005 to 2022 in this analysis. Compared to nonobese individuals, the OR for developing kidney stones in obese participants was 1.35 (95% CI: 1.20 to 1.52, P < .001). Considering geographical location, the OR for the risk of developing kidney stones in obese individuals was 1.51 (95% CI: 1.11 to 2.05, P = .009) in North America, 1.33 (95% CI: 1.16 to 1.51, P < .001) in Europe, and 1.18 (95% CI: 1.08 to 1.29, P < .001) in Asia. Begg's test results (P = .625) demonstrated no publication bias. However, Egger's test results (P = .005) indicated publication bias. Based on the results, obesity increases the risk of kidney stone development. Therefore, community health programs should be implemented to reduce the incidence of obesity and lower the risk of kidney stones.  DOI: 10.52547/ijkd.7223.

Introduction: Recurrence of glomerulonephritis (GN) after kidney transplant (Tx) may be associated with allograft loss. This study aimed to evaluate the frequency and prognosis of de novo or recurrent post-Tx GN.

Methods: We reviewed 1305 kidney Tx biopsy samples obtained between 2006 and 2020. The biopsy specimens were divided into post-Tx GN (recurrent or de novo) and control groups (i.e., no detectable GN in biopsy). Demographic and baseline characteristics of the patients and kidney survival rates were analyzed.

Results: From 1305 kidney transplanted biopsies, 350 repeated biopsies for transplant rejection were excluded. Among 955 analyzed biopsies, (mean age: 40.4 ± 13.48 years, mean transplantation duration: 4.54 ± 3.98 years, 74.6% males), the frequency of GN was 10.78%. The most common recurrent post-Tx GN was IgA nephropathy (22.3%), followed by secondary focal segmental glomerulonephritis (FSGS, 19.4%), primary FSGS (19.4%), and membranous glomerulonephritis (17.5%). In the post-Tx GN group, the mean serum creatinine and proteinuria were 3.28 ± 1.97 mg/dL and 2730 ± 1244 mg/d at the biopsy time and 4.14 ± 1.86 mg/dL and 2020 ± 1048 mg/d, at the end of the study. There was a significant relationship between baseline serum creatinine and graft loss (P < .001). One-, five-, and ten-year graft survival rates were 97%, 81%, and 63% in the postTx GN, and 100%, 92%, and 59% in the control group. The median time to graft loss after biopsy, (graft survival after biopsy), was significantly lower in the post-Tx GN group (P < .000). The other accompanying factors had no significant impact on graft survival.

Conclusion: The median time to graft loss after biopsy was significantly lower in post-Tx GN. Baseline serum creatinine had a significant association with graft loss. Optimal management of recurrent or de novo GN should be a main focus of post-transplant care.  DOI: 10.52547/ijkd.7205.