Iranian journal of kidney diseases最新文献

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.

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.

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.

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.

Introduction: Rhabdomyolysis is a clinical syndrome accompanied with biochemical changes that is diagnosed in some patients with acute chemical or drug poisoning. In this regard, the present study aimed to evaluate the effects of Montelukast in the treatment of intoxication-induced rhabdomyolysis.

Methods: This single-blind randomized clinical trial study was conducted in Loghman Hakim Hospital from March 2021 to March 2022. The study participants were 60 individuals evenly distributed into experimental and control groups. The experimental group received Montelukast plus routine treatment and the control group Creatine phosphokinase (CPK), urea, creatinine, aspartate aminotransferase (AST) and alanine transaminase (ALT) levels were monitored daily in both groups for seven days. The variables of age, gender and history of diabetes mellitus and kidney diseases were recorded.

Results: The mean age was 39.9 ± 16.87 and 38.2 ± 16.3 years in the control and intervention groups, respectively. Montelukast significantly (P < .05) reduced CPK levels on days five and seven, urea on days three, four, five and seven, and creatinine on days two to seven. The AST and ALT levels, unlike the control group which has a decreasing trend, increased first in the Montelukast group and then decreased on the sixth and seventh days.

Conclusion: The results showed that Montelukast effectively reduced CPK, urea and creatinine levels, as well as the recovery time in patients with poison-induced rhabdomyolysis. In other words, Montelukast is effective in the treatment of rhabdomyolysis.

Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary kidney disease that can affect several organs. The clinical course of the disease varies among patients; some never become symptomatic, and others reach end-stage kidney disease (ESKD) in the 5th decade of their life.

Methods: This historical cohort study was conducted on ADPKD patients to investigate kidney and patient survival rates and related risk factors in Iran. Survival analysis and risk ratio calculation were performed using the Cox proportional hazards model, Kaplan- Meier method, and log-rank test.

Results: Among the 145 participants, 67 developed ESKD, and 20 died before the end of the study period. Developing chronic kidney disease (CKD) at the age of ≤ 40, baseline serum creatinine level (SCr) of more than 1.5 mg/dL, and cardiovascular disease increased the risk of ESKD by 4, 1.8, and 2.4 times; respectively. Patient survival analysis revealed a fourfold increase in mortality if the glomerular filtration rate (GFR) declined more than 5 cc/min annually and if CKD was diagnosed at the age of ≤ 40. Vascular thrombotic events or ESKD in the course of disease increased the risk of death by approximately 6- and 7-fold, respectively. Kidney survival was 48% by the age of 60 and 28% by the age of 70. Patient survival was 86.05% at the age of 60 and 67.99% at the age of 70. Additionally, men had a significantly better renal function and survival than women.

Conclusion: Elevated baseline SCr and cardiovascular disease can increase ESKD risk in ADPKD patients. A rapid decline in GFR, ESKD development, and vascular thrombotic events increase the risk of death, but early CKD can affect both.

Introduction: The research was an attempt to explore the potential impact of allicin on lipid peroxidation and oxidative stress in rats diagnosed with chronic kidney disease (CKD), and to determine its underlying mechanism.

Methods: Sixty rats were randomly divided into sham-operated, modelling, and allicin low, medium, and high dose groups. The histopathological structure of the kidney was observed in each group. Biochemical measurements were conducted to assess kidney function, including serum creatinine (Scr) and blood urea nitrogen (BUN), and 24-hour urine protein quantification. Levels of malondialdehyde (MDA), superoxide dismutase (SOD), reactive oxidative species (ROS), and reduced glutathione (GSH) in kidney tissue were measured, and mitogen-activated protein kinase (MAPK) and NF (nuclear factor) -κB protein levels were detected by western blotting.

Results: They showed that allicin improved the pathological structure of renal tissue and protected renal function by reducing oxidative stress and lipid peroxidation via targeting the ROS/ MAPK/NF-κB pathway. Allicin increased SOD and GSH levels, while decreasing Scr, MDA, ROS, BUN, and the amount of protein excreted in urine over a 24-hour in medium and high dose groups. MAPK and NF-κB protein levels in medium and high dose allicin groups were lower than the modelling group.

Conclusion: Based on the results, it can be inferred that allicin may safeguard renal function in rats with CKD and has the potential to serve as a treatment for kidney ailments.  DOI: 10.52547/ijkd.7496.

Introduction: Despite many advances in the development of knowledge and application of new immunosuppressive medications over the past two decades, the improvement has only been seen in the short-term outcome of kidney transplantation while the long-term survival of kidney transplantation has not significantly improved. Allograft kidney biopsy may help to determine the causes of allograft dysfunction which may change the treatment strategy.

Methods: In this retrospective study, kidney transplant recipients who underwent kidney biopsy in Shariati hospital during the years 2004 to 2015, at least three months after the kidney transplantation, were included for evaluation. Chi-square, ANOVA, post-hoc LSD, and T-test were used for data analysis.

Results: A total number of 525 renal transplant biopsies were performed; 300 of them had complete medical records. The reported pathologies consisted of acute T-Cell mediated rejection (TCMR) (17%), interstitial fibrosis and tubular atrophy/chronic allograft nephropathy (IFTA/CAN) (15%), calcineurin inhibitor (CNI) nephrotoxicity (12.8%), borderline changes (10.3%), glomerulonephritis (GN) (8.9%), antibody mediated rejection (ABMR) (6.7%), transplant glomerulopathy (TG) (5.3%), normal (8.4%), and other pathologies (15.6%). C4d was positive in 19.9% of the biopsies. The pathology category had a significant correlation with allograft function (P < .001), but it had no significant relationship with age and gender of the recipient, donor and donor source (P > .05). Moreover, in about 50% of cases, treatment interventions were based on pathological results, which were effective in 77% of cases. The two-year graft and patient survival after kidney biopsy were 89% and 98%, respectively.

Conclusion: Acute TCMR, IFTA/CAN, CNI nephrotoxicity were the most common causes of allograft dysfunction based on the transplanted kidney biopsy. In addition, pathologic reports were helpful for proper treatment.  DOI: 10.52547/ijkd.7256.

Introduction: End stage kidney disease (ESKD) is a life-threatening disorder, which results from loss of function of more than 75% of renal tissue. Many treatment modalities have been attempted for this disease, but only renal transplantation, hemodialysis and peritoneal dialysis have been practically accepted. Each of these methods have certain disadvantages, therefore other treatment modalities are needed for better management of these patients. Colonic dialysis (CD) has been proposed as one of the appropriate candidate methods for the removal of electrolytes, nitrogen waste products and excess fluid, using intestinal fluid environment.

Methods: Super Absorbent Polymer (SAP) were synthesized to be used in CD. The intestinal fluid was simulated in terms of concentrations of nitrogenous waste products, electrolytes, temperature and pressure. The simulated environment was treated with 1 g of synthesized polymer at 37 °C. Concentrations of urea, creatinine and uric acid were measured before and after polymer treating.

Results: Intestinal fluid simulator contained 40g urea, 0.3g creatinine, and 0.25g uric acid. SAP adsorbed up to 4000 to 4400% of its weight in the intestinal fluid simulator (1g polymer can absorb 40g fluid). The amount of urea, creatinine and uric acid decreased to 25g, 0.16g and 0.1g, respectively, in the intestinal fluid simulator.

Conclusion: The present study showed that CD is an appropriate method for removal of electrolytes, nitrogenous waste products and excess fluid from an intestinal fluid simulator. Creatinine is absorbed appropriately in SAP, as a neutral molecule. In contrast, urea and uric acid, as weak acids, are absorbed weakly in polymer network.  DOI: 10.52547/ijkd.6965.

Introduction: Indoxyl sulfate (IS) and para-cresol (p-cresol) are uremic toxins with high protein bonding index that accumulate in the body with decreasing kidney function. The main purpose of the current investigation was to compare the concentration of p-cresol and IS in serum of the type II diabetic individuals with and without nephropathy.

Methods: Fifty-five patients with type II diabetes mellitus were divided into two groups: case and control. The case group consisted of 26 diabetic patients with nephropathy (proteinuria and serum creatinine below 1.5 mg/dL) without any other kidney diseases. The control group included 29 patients without diabetic nephropathy. Patients with advanced heart disease, cerebrovascular accident and other inflammatory or infectious diseases were excluded. Five mL of venous blood was taken from each patient in the morning fasting state. Then other laboratory tests including serum uric acid and creatinine levels, serum urea nitrogen, lipids and glucose were measured by standard methods. P-Cresol and IS levels were measured by the spectrofluorimetric method after extraction. We also filled out a checklist with information regarding the duration of their disease, medication history (oral or injectable), and other demographic information. There were no significant differences between the two groups regarding the investigated factors Results. There were no significant difference among the investigated factors between the two groups (P > .05) except for the serum creatinine, proteinuria and estimated glomerular filtration rate, where the mean values of cases were considerably higher than those of the controls. Serum IS and p-cresol levels were also significantly higher in the case group (P < .05).

Conclusion: According to the findings, it seems that IS, and p-cresol may play a role in the development of diabetic nephropathy and other complications of diabetes mellitus.  DOI: 10.52547/ijkd.7266.