Iranian journal of kidney diseases最新文献

Introduction: Acute kidney injury (AKI) is the most common reported renal complication associated with COVID-19. In this study, we evaluated the frequency of AKI, the predisposing factors, and its impact on the patient's outcomes in COVID-19.

Methods: By collecting retrospective data, we conducted a crosssectional study on hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients in a COVID-19- designated hospital in Shiraz, Iran, from March 2020 to June 2020. Patients' characteristics and laboratory findings were recorded in data gathering sheets. Data were analyzed using SPSS Software Version 16. A P value < .05 was considered significant.

Results: This study was conducted on 980 patients with COVID-19 (mean age: 51.2 ± 16.2 years and men: 54.8%), of which 32.6% developed AKI during their hospitalization period, and 1.3% ended up requiring renal replacement therapy. Patients with higher AKI stages experienced more severe/critical COVID-19 (stage 3: 71.0%, stage 2: 44.8%, stage 1: 6.5%; P < .001). The multivariate analysis showed that the proteinuria had the highest relationship with AKI (OR = 6.77 [95% CI: 4.39 to 10.41], P < .001), followed by in-hospital death (OR = 5.14 [95% CI: 1.86 to 14.47], P = .002). In addition, in-hospital death was more observed in higher stages of AKI (OR = 12.69 [95% CI: 3.85 to 42.09], P < .001).

Conclusions: Hospitalized patients with COVID-19 are vulnerable to AKI, especially those who experienced more severe COVID-19 or require mechanical ventilation, which considerably affects the patients' mortality. The high incidence of AKI in our patients demonstrated that it should be considered as one of the common complications of COVID-19, and diagnostic measures, particularly in severe or critical cases, are recommended.  DOI: 10.52547/ijkd.7636.

Introduction: Diabetic nephropathy (DN) is the most common clinical complication of diabetes mellitus. Moringa isothiocyanate-1 (MIC-1) is effective in the treatment of diabetes mellitus, but its mechanism of action in DN remains obscure. This research specifically probed the role of MIC-1 in modulating renal injury in DN.

Methods: Six db/m mice were assigned to control group and twelve db/db mice were randomly allocated to the db/db and db/db + MIC-1 groups. The body and kidney weights of the mice were monitored. Renal function indicators and oxidative stress-related markers were assessed by automatic biochemical analyzer and ELISA method. The pathological changes, apoptosis of renal tissues, extracellular regulated protein kinases (ERK) 1/2/ Nuclear factor erythroid2-related factor 2 (Nrf2) pathway-related markers, and the positive expressions of podocalyxin (Pod) and synaptopodin (Syn) were measured by H&E, PAS, and TUNEL staining, Western blot, and IHC assay.

Results: MIC-1 reduced the body and kidney weights, and increased the kidney organ index (calculated as 100*kidney weight/ body weight) in db/db mice. In addition, MIC-1 improved renal function, kidney tissue injury, and apoptosis of db/db mice. MIC1 noticeably repressed the contents of reactive oxygen species (ROS) and malondialdehyde (MDA) and enhanced the contents of (glutathione) GSH, superoxide dismutase (SOD), and catalase (CAT) in db/db mice. At molecular level, db/db mice showed a decrease in p-ERK/ERK, Nrf2, SOD-1, heme oxygenase 1 (HO-1), and CAT and an increase in p- inhibitor kappa B alpha (IKBα) and p-Nuclear factor-kappa B (P65/P65), which were reversed when MIC-1 was administered. Furthermore, MIC-1 facilitated the positive expressions of Pod and Syn of the kidney tissues in db/db mice.

Conclusion: MIC-1 reduces oxidative stress and renal injury by activating the ERK/Nrf2/HO-1 signaling and repressing the NFκB signaling in db/db mice.  DOI: 10.52547/ijkd.7515.

Introduction: With the development of information technology in medical treatment, mobile medical treatment has become a new way to seek treatment, follow-up, extended care, popular science, disease prevention and access to disease expertise. The application of mobile medical treatment is relatively mature in the management of chronic diseases. Currently, mobile medical intervention is also introduced in the self-management of patients after Renal Transplantation. Compared with traditional intervention methods, mobile medical treatment has the advantages of convenience, speed, low cost and no geographical restriction, and it is easy to be used by KT recipients in self-management and has good feasibility. Therefore, we conducted self-management intervention for patients after Renal Transplantation based on mobile medical procedures, so as to improve patients' satisfaction, medication compliance, follow-up rate, and ease patients' anxiety about the disease.

Methods: A total of 160 discharged patients with stable recovery of transplanted Renal function who underwent renal transplantation surgery in our hospital from January 2021 to January 2023 were selected for retrospective analysis. According to the different intervention plan, the patients were divided into the intervention group and the comparison group, 80 cases each. Among them, the intervention group used the mobile medical application selfmanagement behavior intervention, and the comparison group used the conventional self-management behavior intervention. The differences of self-management behavior score, quality of life score, Basel score and anxiety score between the two groups of patients after Renal Transplantation were analyzed and compared.

Results: After intervention, there were statistically significant differences in the scores of self-management behavior scale, Quality of life related rating scale, Basel Assessment scale and Self-rating Anxiety Scale between the intervention group and the control group (P < .05).

Conclusion: Mobile health intervention tools can provide efficient, comprehensive and accurate remote health intervention and professional support for patients, optimize the medical service system, and meet the social medical needs of high-quality nursing services.  DOI: 10.52547/ijkd.7693.

Introduction: Graphene-based nanomaterials have shown some degrees of stem cell protection against cell death. Due to their distinctive function, the kidneys are exposed to many toxic substances. On the other hand, minor and trivial effects of stem cells have been reported for the treatment of acute kidney injury (AKI). Here, we explain the use of Graphene oxide (GO) for improving the efficacy of mesenchymal stem cells (MSCs) in the treatment of Cisplatin-induced AKI.

Methods: In this study, GO particles were synthesized in our lab. Cisplatin-induced AKI was modeled on rats. Thirty adults male Wistar Albino rats were divided into five groups: control group (did not receive any treatment), Cisplatin group (received 5 mg/ kg cisplatin intraperitoneally), sham group (received 500 µL saline intraperitoneally 5th days after Cisplatin injection), [Cisplatin + MSCs] group (received 5×106 /kg MSCs after Cisplatin injection), and [Cisplatin+ MSCs + GO] group (received 1.5 mg/kg GO + MSCs after Cisplatin injection. Biochemical analysis of serum creatinine (Cr) and blood urea nitrogen (BUN) levels, as well as histological study of the kidneys in diverse groups were compared. The oneway analysis of variance (ANOVA) and Dunnett's test were used for comparisons between the study groups.

Results: GO improved the effects of MSCs transplantation on serum Cr and BUN in AKI rat models. It also reduced cell death, hyaline casts, and cell debris in the animal models compared to the MSCs group.

Conclusion: It could be concluded that GO can enhance the efficacy of MSCs transplantation in the treatment of damaged kidneys.  DOI: 10.52547/ijkd.7472.

Ntroduction: Hyperhomocysteinemia is an important risk factor for cardiovascular disease in ESKD patients. Homocysteine, as an inflammatory factor, and carotid intima-media thickness (CIMT) could predict atherosclerosis in hemodialysis-treated ESKD patients. In this regard, the present study was conducted to investigate serum homocysteine level and its relationship with internal carotid intima thickness in ESKD patients undergoing routine hemodialysis.

Methods: This study comprised 56 ESKD patients, older than 40 years, undergoing hemodialysis for at least 1 year. All participants were taking Nephrovit for at least 6 months. The study participants were patients who underwent ultrasonography for CIMT determination and laboratory test Results. There was no statistically significant relationship between the mean homocysteine level and hypertension, diabetes mellitus, duration of dialysis, and body mass index (BMI). Among the study participants, the results also showed that the mean value of CMIT homocysteine and C-reactive protein (CRP) were 0.89 millimeters, 30.44 (mcmol/L), and 35.60 mg/L; respectively. Despite hypertension, there was a significant difference between the mean values of CMIT in patients with diabetes mellitus and those who had been on dialysis for a longer period (more than 3 years). Also, the mean value of CMIT was significantly higher in obese patients than those with normal BMI. None of the other variables including homocysteine serum level, C-reactive protein (CRP), and CMIT showed a significant correlation.

Conclusion: The results of the study suggest that there is no relationship between serum homocysteine level and carotid intima-media thickness in hemodialysis patients.  DOI: 10.52547/ijkd.7424.

Introductions: Contrast-induced nephropathy (CIN) is an important issue in patients with cardiovascular disorders undergoing angiography, especially in patients with kidney failure. The purpose of the present study was to compare the preventive effects of nicorandil and atorvastatin on the incidence of CIN in patients with chronic kidney disease (CKD).

Methods: In this clinical trial study, 270 patients with renal insufficiency nominated for angiographic procedures were randomly divided into three groups (each group, n = 90): hydration group (1000 mL saline), hydration + atorvastatin group (80 mg/d for 3 days), and hydration + nicorandil group (10 mg 3 times/d for 3 days). Serum creatinine (Cr) and blood urea nitrogen (BUN) levels as well as glomerular filtration rate (GFR) were evaluated before and 72 hours after the intervention.

Results: At the end of the study, serum Cr and BUN levels in all three groups showed a significant increase compared to the pre-intervention levels, which were significantly higher in the control group than the other two groups. The amount of GFR also significantly decreased following the intervention in all three groups, with the decline being significantly more pronounced in the control group than in other two groups. No significant differences were found in serum concentrations of Cr and BUN as well as GFR levels between nicorandil and atorvastatin groups at the end of the study.

Conclusion: Nicorandil and atorvastatin administration showed preventive effects on CIN in CKD patients undergoing angiography, but there was no significant difference between the two drugs.  DOI: 10.52547/ijkd.7348.

Introduction: Early diagnosis and management of preeclampsia are very important to reduce fetal and maternal complications. In this study, we examined the ratio of protein to creatinine in a random urine sample and its relationship to the rate of 24-hour urine protein excretion for quick detection and prompt management of this condition in women with preeclampsia.

Methods: In this descriptive-analytical cross-sectional study, 60 pregnant women with preeclampsia referred to the maternity ward of Ali Ebn -e Abitaleb hospital of Zahedan in 2019 were recruited. The 24-hour urine protein excretion and the ratio of protein to creatinine in a random urine sample were compared in these patients.

Results: The results showed that there was a positive correlation between the 24-hour urinary protein excretion and the protein to creatinine ratio of the random urine sample in preeclampsia (P < .001, r = 0.515). Women with a higher 24-hour protein excretion also had a higher urinary protein to creatinine ratio.

Conclusion: In general, based on the results of this study, it can be concluded that the ratio of protein to creatinine in the random urine sample has a good diagnostic efficiency in suspected preeclampsia. It is a quick alternative method for detecting suspicious proteinuria and could be used as a screening test in emergency situations.  DOI: 10.52547/ijkd.7457.

Introduction: Central venous catheters, frequently used in patients undergoing hemodialysis, place the patients at high risk of catheter-related infections. Therefore, it is essential to select the optimal prevention protocol for these infections. This study aims to compare the efficacy of the Taurolock solution and antibiotic lock in preventing tunneled catheter (permcath) related infections.

Methods: This multicenter study was conducted between June 2020 and July 2021 on 86 hemodialysis patients with a central venous catheter from four dialysis centers in Tehran, Iran. The patients were randomly assigned into two groups. The first group received Taurolock, and the second group received antibiotic lock (a combination of vancomycin and heparin) at the end of each dialysis session. Peripheral blood and catheter blood samples were collected once before the intervention and monthly thereafter, for up to six months, and blood culture performed for detection of various bacterial strains.

Results: The findings showed no significant difference in the infection rate (positive peripheral blood or catheter cultures) between the Taurolock and vancomycin groups (P > .05). Additionally, there was no significant difference in the duration of catheter implantation in individuals with positive and negative cultures (P > .05). Furthermore, no significant correlation was found between comorbidities and catheter-related infection in patients of the two groups (P > .05).

Conclusion: There was no significant difference between the two groups in the rate of catheter-related infection. Therefore, vancomycin lock solutions can be good alternatives to Taurolock solution for preventing catheter-related infections.  DOI: 10.52547/ijkd.7615.

Introduction: This study was conducted to determine the factors affecting the development of sarcopenias in elderly patients with chronic kidney disease (CKD), in order to provide future clinical reference and guidance in preventing the occurrence of sarcopenias in patients with CKD.

Methods: We included 116 CKD patients admitted to affiliated Hospital of Hebei University for retrospective analysis between September 2019 and March 2022. Fifty-one CKD patients with sarcopenias were selected as the observation group (OG) and 65 CKD patients without sarcopenias were considered as the control group (CG). Clinical baseline data such as age and sex were recorded, venous blood was collected for routine examination, and a multi-frequency body composition analyzer was applied to measure patients' body composition. Grip strength, middle arm circumstances (MAC) and triceps skin-fold thickness (TSF) were also measured. Then, patients' sleep quality, nutritional status and negative psychological status were assessed by using the Pittsburgh Sleep Quality Index (PSQI), Malnutrition inflammation score (MIS), and Self-rating Anxiety/Depression Scale (SAS/SDS), respectively. Differences in test results were compared inter-group, and the factors affecting the occurrence of sarcopenias in CKD patients were analyzed by multiple Logistic regression.

Results: OG patients were older than CG patients, with a higher number of female patients. Their BMI, bone mass, MAC, serum creatinine (Scr), uric acid (UA) and triglyceride (TG) were lower (P < .05). According to multiple Logistic regression analysis, age, as well as PSQI, MIS, SAS, and SDS scores were the risk factors for sarcopenias in CKD, while BMI, bone mass, MAC, Scr, UA and TG were protective factors (P < .05).

Conclusion: Age, poor sleep quality, poor nutritional status and negative emotions are independent risk factors for sarcopenias in CKD patients, while BMI, bone mass, MAC, UA, TG, and Scr are independent protective factors.  DOI: 10.52547/ijkd.7537.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors modulate kidney function in diabetic chronic kidney disease trials. Furthermore, recent studies have showed their effect on kidney dysfunction in non-diabetic chronic kidney disease (CKD). Here, we focus on the impact of SGLT2 inhibitors on some renal parameters in nondiabetic CKD by discussing completed and ongoing trials. Different databases and search engines of Web of Science, PubMed, Google Scholar, Scopus, SID, and Magiran were searched until November 2022. We included human studies that evaluated the effect of SGLT2 inhibitors in non-diabetic CKD participants. Two authors independently screened the articles for inclusion, extracted the data, and assessed the quality of the included studies. The primary outcomes were the effect of the SGLT2 inhibitors on proteinuria, GFR and blood pressure. A total of 46 full texts were assessed for eligibility, and further review. After reviewing the full texts, seven eligible articles were entered included in this study. We suggest that SGLT2 inhibitors provide renal protection by modifying predisposing factors in the development of CKD, specifically albuminuria and GFR decrease. Other beneficial effects of these agents on blood pressure and sympathetic nerve activity might be considered as a possible mechanism for improving renal hemodynamics. We believe SGLT2 inhibitors could be considered as an effective add-on therapy in non-diabetic CKD patients.  DOI: 10.52547/ijkd.7309.