Iranian journal of kidney diseases最新文献

In this brief communication, we reemphasize the importance of critical thinking in clinical practice using the example of edema. The common practice of thinking and inquiry by practicing clinicians has beneficial implications for healthcare by improving outcomes and patient care while alleviating the burden of misconceptions in practice. We provide an in-depth and interactive investigation of physiological concepts as a foundation for understanding body fluid dynamics. Finally, we offer a new classification of symptoms of heart failure. DOI: 10.52547/ijkd.8171.

Introduction: To investigate the risk factors of Programmed Cell Death Protein 1 (PD-1), Programmed Cell Death Ligand 1(PD-L1) inhibitor associated acute kidney injury (AKI) in patients with primary non-small cell lung cancer (NSCLC) and construct a predictive model.

Methods: 120 NSCLC patients were selected as the research subjects and their clinical data were collected. Patients were divided into AKI and Non-AKI (N-AKI) group based on the development of AKI. Exploring the risk factors of PD-1P/D-L1 inhibitor related AKI in NSCLC patients using multivariate logistic regression analysis and visualized the logistic regression analysis to obtain a nomogram model. Meanwhile, evaluate the predictive value of the model.

Results: The results of multivariate analysis showed that the presence of extrarenal immune related adverse reactions (irAEs) is a risk factor for PD-1/PD-L1 inhibitor related AKI in NSCLC patients; At the same time, the risk of developing PD-1/PD-L1 inhibitor related AKI in NSCLC patients increases with increasing serum creatinine (SCr) and C-reactive protein (CRP) levels, decreasing baseline estimated glomerular filtration rate (eGFR) levels (P < .05). The analysis results of receiver operator characteristic curve (ROC), calibration curve, and decision curve show that the model has good discrimination and accuracy, and can achieve a high clinical benefit rate.

Conclusion: Primary NSCLC patients with extrarenal irAEs, high levels of SCr and CRP, and low levels of eGFR have a higher risk of AKI after PD-1/PD-L1 inhibitor treatment. Establishing a predictive model with high accuracy is more conducive to early detection of high-risk patients. DOI: 10.52547/ijkd.7964.

Introduction: We aimed to examine the clinical characteristics of peritoneal dialysis (PD) patients with different baseline peritoneal transport characteristics and the effect of peritoneal transport characteristics on the prognosis of PD patients.

Methods: Patients who received PD for more than 3 months were included. Clinical characteristics, risk factors for high peritoneal transport, and risk factors for death and technique failure were examined. All patients were treated with glucose-containing peritoneal dialysis solution, and the peritoneal dialysis protocol was either day ambulatory peritoneal dialysis (DAPD) or continuous ambulatory peritoneal dialysis (CAPD).

Results: A total of 351 patients were enrolled, comprising 70 in the low transport group, 149 in the low average transport group, 88 in the high average transport group, and 44 in the high transport group. Multivariate logistic regression analysis showed that a high Charlson's comorbidity index (CCI) and low albumin were risk factors for a high baseline transport status. In the nonhigh transport group, the proportion of patients with albumin less than 30 g/L, who developed high transport status, was higher than those with albumin more than 30 g/L (P = .029). The survival rate in the high transport group was significantly lower than that in the other three groups (P < .001). Multivariate Cox regression analysis showed that age, systolic blood pressure, CCI, C-reactive protein (CRP) and high transport were independent risk factors for all-cause mortality. Male sex, triglycerides and CRP were independent risk factors for technique failure.

Conclusion: High peritoneal transport status is an independent risk factor for death. High CCI and low albumin are determinants of baseline high peritoneal transport. To avoid development of a high transport state, serum albumin should be increased to more than 30 g/L.

Introduction: This study was an attempt to detect the relationship between chronic kidney disease (CKD) and anthropometric indices in presence of confounding variables.

Methods: A cross-sectional study of 3375 participants was designed in Isfahan city. Waist-height ratio (WHtR), waist-hip ratio (WHR), body mass index (BMI) and waist circumference (WC) were measured. Participants were divided into CKD and non-CKD groups according to the calculated albumin to creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). Then, the groups were subdivided into sub-groups of high and normal anthropometric indices.

Results: To evaluate CKD in relation to anthropometric indices, odds ratio was calculated; in the female group, no association was observed (P ˃ .05). However, in the male group high levels of WHtR and BMI were associated with CKD (P value of .002 and .015, respectively). To evaluate the association between ACR and eGFR with anthropometric indices linear regression analysis was performed. There was no significant relation between ACR and eGFR with anthropometric indices in both sexes in a fully adjusted state (P ˃ .05).

Conclusion: High WHtR and BMI probably are associated with CKD in male. WHR and WC have no relation to the occurrence of CKD. There are no significant changes in regard to ACR and eGFR.

Introduction: Pauci-immune crescentic glomerulonephritis (GN) is the most common cause of rapidly progressive GN in adults. The aim of this study was to determine the outcome of patients with pauci-immune crescentic GN and risk factors of the development of end-stage kidney disease (ESKD) in these patients.

Methods: This case series study was carried on 120 patients with pauci-immune crescentic GN biopsied in our center betwen 1998 and 2016. Inclusion criteria were age > 16 years, at least one crescentic glomerulus, maximally 1+ deposition of immunoglobulins and complement components at fluorescent microscopy, and at least 6 months follow-up. The main outcomes were ESKD and death.

Results: The study population included 120 patients with pauciimmune crescentic GN (mean age was 47 ± 17 years and 49.1% male). There was no significant difference in outcome between patients with diffuse or focal crescentic GN. Seventy-two patients (60%) developed ESKD and 31 patients (25.8%) died. The need for dialysis at admission, lower baseline hemoglobin and GFR and GFR at four months and high percentage of glomerulosclerosis and interstitial fibrosis had a significant relationship with low kidney survival (P < .05). The rate of ESKD was higher in patients who did not receive cyclophosphamide therapy, due to focal crescentic GN or high chronicity, compared to patients who received it (70.7 vs. 28.5%, P < .001).

Conclusion: In our study, a high percentage of patients with pauciimmune crescentic GN developed ESKD. Low first GFR and high chronicity in biopsy were associated with lower kidney survival. Failure to administer cyclophosphamide in seemingly limited or advanced cases, together with late referral may have led to poor prognosis.