Iranian journal of kidney diseases最新文献

This study presents a comprehensive review of the literature regarding the use of urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a diagnostic tool for urinary tract infection (UTI) in children. Meta-analysis was conducted to evaluate the effectiveness of uNGAL in diagnosing UTI and differentiating acute pyelonephritis (APN) from other sites infection in pediatric patients. We searched PubMed, Web of Science, the Cochrane Library and EMBASE for reports published up to January 2023. We only included published literature that addressed the diagnosis of UTI and APN with the use of uNGAL in children aged 0-18 years. Two authors independently reviewed the included studies and extracted the corresponding data according to the inclusion and exclusion criteria. The sensitivity, specificity and area under the curve for each study were pooled by using a bivariate mixed-effects model. A total of 13 studies met the inclusion criteria for this review: 8 reported on uNGAL diagnosis of UTI, 2 on uNGAL diagnosis of APN, and 3 on both UTI and APN. Among all included studies, uNGAL had good sensitivity (0.88, 95% CI 0.79-0.94) and good specificity (0.86, 95% CI 0.78-0.92) for the diagnosis of UTI. The sensitivity and specificity of uNGAL for the diagnosis of APN were 0.79 (95% CI 0.72-0.85) and 0.78 (95% CI 0.50-0.93), respectively. uNGAL has good sensitivity and specificity in the diagnosis of UTI in children and is a promising marker. However, the use of uNGAL still does not provide significant advantages in the diagnosis of APN in children. Consequently, there is a need to optimize and further explore the assay for improved diagnostic accuracy.

Introduction: Acute kidney injury (AKI) is a prevalent complication of liver transplantation, leading to prolonged hospital or intensive care unit stay and significant morbidity. Recently, biomarkers such as neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C have been investigated for their potential role in the early detection of AKI in liver transplantation patients.

Method: Our study comprised 60 patients with end-stage liver disease undergoing living donor liver transplantation. Based on the postoperative development of AKI, the patients were categorised into two groups: the AKI group comprising 22 patients and the non-AKI group comprising 38 patients. Serum cystatin C and urine NGAL levels were measured twice: immediately after induction of anaesthesia (baseline) and at the end of the surgery.

Results: The overall incidence of AKI was 36.66%. The mean cystatin C level measured at the end of the surgery was significantly higher in the AKI group (1.12 ± 0.40 mg/L) than in the non-AKI group (0.82 ± 0.27 mg/L) [P = .001]. The receiver operating characteristic curve for the postoperative cystatin C biomarker demonstrated a significant difference between the AKI and non-AKI groups [area under the curve: 0.71, P = .007]. However, baseline cystatin C and urine NGAL levels did not significantly differ between the groups.

Conclusion: Cystatin C levels measured at the end of the surgery showed a better predictive value and higher accuracy in identifying post-liver transplantation patients with AKI than baseline cystatin C and urine NGAL.

Introduction: Continuous renal replacement therapy (CRRT) is effective in treating acute kidney injury (AKI), but it requires anticoagulants. The study was conducted to compare the anticoagulant effect of low-molecular-weight heparin (LMWH) sodium and sodium citrate on AKI patients treated by CRRT.

Methods: The medical records of 150 severe AKI patients treated by CRRT in the Second Affiliated Hospital of Hainan Medical College (China, Hainan) from January 2020 to January 2023 were analyzed retrospectively. LMWH sodium was administered as an anticoagulant for 72 patients in the control group, and the remaining 78 receiving sodium citrate were enrolled into the observation group. Outcomes compared between groups included coagulation indices, inflammatory factors and renal function indices prior and post therapy, filter lifespan and adverse reactions.

Results: Post therapy, in contrast to the control group, the observation group showed notably lower prothrombin time (PT) and activated partial thromboplastin time (APTT) levels and a notably higher platelet (PLT) level (P < .05) and presented notably lower C-reactive protein (CRP) and interleukin-6 (IL-6) levels (P < .05). In contrast to the control group, the observation group experienced a notably longer filter service life and a notably lower total incidence of adverse reactions (P < .05).

Conclusion: Sodium citrate had a better anticoagulant effect than LMWH for severe AKI patients treated by CRRT, improving renal function and filter longevity with fewer adverse effects.

Fabry disease (FD) is a rare X-linked genetic disease that can coexist with multiple glomerulopathies. We report a 32-year-old female patient of FD coexisting with stage II membranous nephropathy (MN), who presented with proteinuria, normal renal function, and hypo-hidrosis as the only symptom. The renal biopsy manifested a subepithelial immunocomplex deposit in the glomeruli along with basement membrane thickening on light microscopy. Electron microscopy revealed myeloid bodies in some podocytes, which suggested the patient possibly coexistence with Fabry disease. The low activity of α-galactosidase A and one pathogenic heterozygous mutation (c.335G > Ap.Arg112His) in the α-galactosidase A gene confirmed the diagnosis of Fabry disease. This patient's son had the same gene mutation as his mother but without any symptoms at the time. Treatment with ramipril turned urine protein negative. The proteinuria had reoccurred, as shown by the presence of foamy urine, a protein to creatinine ratio of 1.54 g/g, and a blood albumin level of 34.4g/L. The patient was being treated with allisartan isoproxil. However, at the time, the urine protein did not turn negative.

Introduction: Peritoneal dialysis utilizes two distinct double-bag exchange systems (ANDY-Disc from Fresenius Medical Care in Bad Homburg, Germany, and DIANEAL from Baxter in Deerfield, IL). These systems are widely used across the globe. The long-term outcomes of peritonitis with different types of treatment are still questionable. Therefore, we conducted a retrospective comparative cohort study to assess the long-term impact of these two distinct exchange procedures on the true peritonitis rate and the technique durability in real-world settings.

Methods: One hundred and twenty patients, treated with a double-bag exchange system in a Songklanagarind Hospital, located in the south of Thailand from January 2009 to December 2020 were included. The primary outcome was the incidence rate of peritonitis by treatment arm (ANDY-disc and DIANEAL). Secondary outcomes included the pathogenic organism causing peritonitis, time to the first peritonitis, and survival technique between the two systems.

Results: The peritonitis rate for patients using the ANDY-disc in continuous ambulatory peritoneal dialysis (CAPD) was 0.28 episodes per patient-year, while the DIANEAL group had a rate of 0.29 episodes per patient-year. There was no difference in the peritonitis rate between the two groups (P = .816). Gram-positive bacterial peritonitis accounted for 33.4% in the ANDY-disc arm and 43.7% in the DIANEAL arm. The 10-year technique survival was 86.1% in the ANDY-Disc group and 73.5% in the DIANEAL group; this did not reach statistical significance.

Conclusion: The ANDY-Disc and DIANEAL exchange systems are comparable in the long-term incidence of peritonitis. Both systems have similar long-term technique survival. However, this should be confirmed by a high-quality trial.

Introduction: Antibody mediated rejection (AMR) is a major challenge in kidney transplantation and adversely affects allograft survival. Oxidative stress (OS) is implicated in AMR pathogenesis by triggering inflammation, apoptosis and fibrosis in the graft tissue. However, the status of OS and antioxidant defense in AMR patients remains unclear. We aimed to evaluate the levels of OS markers and antioxidant enzymes in AMR patients.  Methods. We conducted a case-control study involving 22 biopsy-proven AMR patients (test group) and 14 kidney recipients with stable graft function (control group). Serum total oxidant status (TOS), total antioxidant capacity (TAC), total thiol groups, nitric oxide (NO), 8-isoprostane (8-IP) were determined and activities of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) were measured by spectrophotometric methods.

Results: Data analysis showed significant increases in TOS, TAC and 8-IP levels together with marked reductions in NO and total thiol groups in AMR patients. CAT and GPx activities did not differ between groups, however SOD activity was significantly lower in AMR patients.

Conclusion: Our study showed increased OS and impaired antioxidant defense in AMR patients. NO level may serve as a potential biomarker of OS severity and immune response in AMR. Further studies are required to elucidate the mechanisms and consequences of OS in AMR and to explore the therapeutic potential of antioxidants.

Familial hypomagnesemia with hypercalciuria and nephrocalcinosis (FHHNC) is an autosomal recessive disorder that affect children and young adults. Mutation in gene that coding the tight junction proteins Claudin-16 and Claudin-19(CLDN19) is responsible of this rare disorder. Hypomagnesemia, hypercalciuria, kidney failure and visual impairment (in CLDN 19 gene mutation) are the most common presentations of FHHNC. Here we present a 31-year-old woman with end-stage kidney disease (ESKD) on routine hemodialysis for the past eight years and was referred to Firoozgar nephrology clinic for kidney transplantation. Her past medical history included recurrent kidney stones. Although FHHNC is a rare disease, genetic evaluation recommended in patients with ESKD and concomitant nephrocalcinosis.

Introduction: Despite the significant decline in the incidence of pregnancy-related acute kidney injury (AKI) in recent decades due to advancements in medicine and increased awareness of this disease, it remains an important risk factor for maternal morbidity and mortality. However, as fertilization techniques allow women of advanced age to become pregnant, the incidence of pregnancy-related AKI has increased. Consequently, early identification of and intervention for pregnancy-related AKI are particularly important.

Methods: This was a retrospective clinical analysis. Data were collected from pregnant patients who were treated in the ICU of Shengjing Hospital of China Medical University from January 2014 to June 2020; The patients were divided into two groups based on their kidney function status: AKI and non-AKI. Additionally, they were further categorized into recovered and non-recovered groups based on their prognosis. The Wilcoxon rank sum test and the chi-square test were used for multigroup comparisons, while logistic regression analysis was used for the analysis of risk factors. P < .05 was considered to indicate a statistically significant difference in all correlation analyses.

Results: Among 874 pregnant women in this study, 136 had AKI (15.56%), while 36 developed chronic renal insufficiency (26.47%). Statistically significant associations were shown for shock (P = .002), sepsis (P < .001), coagulopathies (P = .001), liver insufficiency (P < .001), postpartum hemorrhage (P = .016), intrauterine fetal death (P = .042) and mechanical ventilation (P = .006) between the AKI-group and the non-AKI group. The development of AKI based on an elevated baseline creatinine level was significantly related to the outcome of renal function (P < .001), while a significant difference was shown in the use of continuous renal replacement therapy (CRRT) between the recovery group and the non-recovery group (P = .023).

Conclusion: We identified the relevant risk factors leading to pregnancy-related AKI and affecting the patients' prognosis. Shock, sepsis, coagulation disorders, liver insufficiency, postpartum hemorrhage, intrauterine fetal death and mechanical ventilation are independent risk factors for pregnancy-related AKI, while an elevated baseline creatine level is a key factor for poor prognosis. Meanwhile, early CRRT can effectively reverse renal outcomes.

Introduction: In recent years, the incidence of pediatric nephrotic syndrome (NS) has been increasing, and timely and effective treatment is critical to protect the health of children with NS. This study is an attempt to compare the therapeutic effects of prednisone  (Pred) plus dipyridamole (DIP) versus Pred plus valsartan (VAL)on pediatric NS.

Methods: Two hundred pediatric cases of NS were selected as the research participants, including 109 cases (group A) receiving Pred + DIP and 91 cases (group B) receiving Pred + VAL. The clinical efficacy, adverse reactions, and renal, coagulation functions and blood lipid levels, as well as the pre- and post-treatment levels of inflammatory factors (IFs) and immunoglobulins (Igs) were comparatively analyzed.

Results: No statistically significant differences were found between groups in terms of clinical efficacy, incidence of adverse reactions and renal function (P > .05). After receiving the corresponding treatment, group A showed better coagulation and immune functions than group B, but higher levels of IFs and poorer blood lipid function (P < .05).

Conclusion: Both Pred + DIP and Pred + VAL combination therapies can be used for the treatment of pediatric NS, with the former contributing to more obviously enhanced coagulation and immune functions, and the latter leading to more significantly inhibited inflammation and better regulated blood lipid function.

Introduction: Ambulatory blood pressure monitoring (ABPM) is a valuable tool for detecting abnormalities in nighttime blood pressure (BP), including non-dipping and nighttime hypertension. These abnormalities are independent predictors of a poor prognosis in patients with chronic kidney disease (CKD). The aim of our study  was to analyze ABPM data and evaluate nighttime BP abnormalities in an Iranian CKD population.

Methods: This cross-sectional study was conducted on sixty two patients at stages III and IV of CKD who were referred to a nephrology clinic in Tehran, Iran. The patients were classified as either dippers (19.4%) or non-dippers (80.6%), as well as nighttime normotensives (38.7%) or hypertensives (61.3%), based on ABPM  data and in accordance with 2023 ESC/ESH guidelines. We compared demographic data, estimated glomerular filtration rate (eGFR), and daytime BP levels among these groups.

Results: The mean age of patients was 56.34 years, with 61.1% of them being male. Daytime pulse pressure was significantly greater in non-dippers compared to dippers (52.67 vs. 44 mmHg, P = .02). We found a significant correlation between the extent of BP dipping and eGFR (R = 0.281, P = .02). Systolic and diastolic daytime BP levels were significantly higher in individuals with nighttime hypertension. Diabetic patients were more likely to be non-dippers and have nighttime hypertension. After adjusting for age, diabetes mellitus, and daytime pulse pressure in a multivariable model, we determined that eGFR independently predicted the  extent of BP dipping.

Conclusion: Our results showed that both non-dipping and nighttime hypertension are highly prevalent in CKD patients, but they have distinct contributing factors. The eGFR was identified as an independent predictor of BP dipping, whereas nighttime BP levels were primarily determined by daytime BP levels. DOI: 10.52547/ijkd.7559.