Introduction: Hydronephrosis, a condition that is mostly congenital, is considered as the most common type of pediatric urinary tract disorder. The aim of this study was the evaluation of the prognosis and outcomes of hydronephrosis in cases of congenital hydronephrosis.
Methods: In a cross-sectional study, run in a tertiary clinic of pediatric nephrology, from 2015 to 2020, patients with fetal hydronephrosis were selected. Ultrasonography, urinalysis and kidney function tests were ordered for all patients and in the presence of hydronephrosis, repeated ultrasonography, voiding cystourethrography and dimercaptosuccinic acid scan were performed. In cases with evidence of obstruction, a diethylenetriamine pentaacetic acid scan and relative surgical procedures were performed.
Results: Among 141 cases, mean age was 8 ± 1.4 years and 80.9% were male. Partial or complete obstruction in the right and left kidney was found in 16.3 and 24.8% of patients, respectively. The degree of hydronephrosis was mild in 46.1%, moderate in 39%, and severe in 9.2% of the patients. At the last follow-up period, hydronephrosis recovered in 46% of the patients, while 54% experienced persistence or exacerbation of the disease. Meanwhile, 7.1% of patients showed neurogenic bladder, 19.1% urinary tract infection and 22.7% urinary stones.
Conclusion: Our study revealed that fetal hydronephrosis ends in complete recovery following birth in 46% of the cases. However, in cases experiencing persistent or exacerbating hydronephrosis, optimized treatment and/or surgical intervention are required. DOI: 10.52547/ijkd.6516.
Introduction: The rates of morbidity and mortality in patients receiving routine hemodialysis have been demonstrated to be significantly affected by the dose of HD. As the national and international standards for determination of dialysis adequacy vary among countries, it is necessary to investigate the optimum criteria for HD adequacy. In this study, we aimed at comparing HD adequacy, through two methods of OCM with electrical conductance, and blood-driven Kt/V of urea, in the largest hemodialysis center in Iran.
Methods: The value of UC, as an indicator of HD adequacy, was measured 301 times in 120 HD patients via two methods of OCM and blood-driven clearance of urea. For urea- driven Kt/V, two blood samples, each 2 milliliters, were taken from the patient, one before and one after a HD session. For OCM, Fresenius 4008 dialysis machine was set online once the patient was receiving HD. The results of these two methods were analyzed regarding the correlation with patients' demographics, BMI, required weekly HD sessions, type of HD access, type of dialyzers, hematocrit, UDV, ultrafiltration, and blood flow rate.
Results: The mean values of UC obtained from blood samples and OCM were almost similar and not significantly different (1.20 vs. 1.11, P = .50). UC values, measured by laboratory assessments were significantly associated with gender, BMI and UDV, while UC values from OCM were significantly associated with gender, BMI, dialyzer type, UDV and ultrafiltration.
Conclusions: We conclude that OCM can be used as an effective substitute for laboratory assessment in HD centers to assess HD adequacy. DOI: 10.52547/ijkd.6787.
It remains controversial, whether vitamin D reduces urinary albumin excretion in patients with diabetic nephropathy (DN). This metaanalysis was designed to evaluate the therapeutic effect of vitamin D, on urinary albumin excretion, in DN patients. Electronic databases, including PubMed, Embase, Web of Science, and Cochrane library were searched for randomized controlled trials (RCTs), regarding the effect of vitamin D on urinary albumin excretion in DN patients. The study selection and data extraction were conducted by two reviewers independently, and statistical analysis was performed using RevMan software, version 5.2. A total of nine RCTs including 1547 subjects were qualified. There were 815 participants in the study group and 732 in the control group. The fixed-effect model was used to analyze urinary albumin creatinine ratio (UACR) and urinary albumin excretion ratio (UAER), and the pooled standard mean difference (SMD) was -0.24 (95% CI: -0.39 to -0.09), P = .002, and -0.57 (95% CI: -0.71 to -0.43), P < .00001; respectively. These findings indicated that vitamin D-treated patients had a statistically significant reduction in UACR and UAER. High-quality RCTs are still required. DOI: 10.52547/ijkd.7107.
Introduction: Currently There is no noninvasive chemical biomarker, available for evaluating volume status, in individuals with endstage kidney disease (ESKD). This study aimed to determine the relationship between copeptin level and volume status in hemodialysis patients.
Methods: This clinical trial enrolled 84 patients with ESKD (Mean age ± SD: 54.31 ± 15.47) on maintenance hemodialysis (3-times weekly, 4h /session). Plasma levels of Hb, copeptin, HCT, Na, and BUN, patients' weight, systolic and diastolic blood pressure and mean arterial pressure were measured, before and after hemodialysis. Age, sex, etiology of kidney failure, and duration of dialysis were also recorded., and the correlation between copeptin level and all variables was evaluated.
Results: There was a significant positive correlation between copeptin level and Hb (r = 0.313, P < .05), and HCT (r = 0.25, P < .05), while a negative association was found between copeptin level and Na (r = -0.051, P > .05) and IDWG (r = -0.05, P > .05). Although copeptin concentration was higher in females before (929.23 pmol/L) and after dialysis (783.3 pmol/L) than male patients (657.05 and 697.45 pmol/L), the mean copeptin changes was higher in male (205 pmol/L) than female (197 pmol/L) (P > .05). The level of copeptin decreased (P > .05) but the level of Hb (P < .05), HCT (P < .05), and Na (P > .05) were increased after dialysis compared to pre-dialysis period.
Conclusions: Copeptin could be used as a surrogate marker for the diagnosis of volume status in hemodialysis patients. DOI: 10.52547/ijkd.7119.
Introduction: Early diagnosis of diabetic nephropathy (DN), the leading cause of death in diabetic patients, is an important issue in preventing and reducing the disease burden for patients and the healthcare system. In this study, we aimed at investigating the value of color doppler ultrasonography in the diagnosis of early diabetic nephropathy (DN).
Methods: Two hundred and thirty-eight diabetic patients, were enrolled in this study and were categorized into, either control (n = 109) or study group (n = 129), according to 24 hours urinary albumin excretion rate (UAER), from January 2015 to March 2021. The morphologic findings of the kidneys were observed and compared, in both groups, by color doppler ultrasound technique, and blood flow of renal arteries was also measured, at all levels. Fasting plasma glucose (FPG), uric acid, homocysteine, beta-2- microglobulin, cystatin C, hemoglobin A1c (HbA1c) and CRP were also extracted from their laboratory results.
Results: Compared to the control group, the study group had lower intrarenal arterial end-diastolic blood flow velocity (EDV) and higher arterial resistance index (RI) (P ~ < .05). A significant diagnostic value of intrarenal arterial EDV and RI was found for early detection of DN (P ~ < .05). Intrarenal arterial RI and EDV showed positive correlations with UAER, FPG, uric acid, homocysteine, beta-2-microglobulin, cystatin C, HbA1c, and CRP (P ~ < .05).
Conclusion: Color doppler ultrasound markers of renal and intrarenal arteries has a high diagnostic value for DN at its early stage. DOI: 10.52547/ijkd.7246.
Introduction: As a multisystem illness, Coronavirus disease 2019 (COVID-19) can damage different organs. This study investigated the effect of electrolyte imbalance (EI), with or without concomitant renal dysfunction, on the prognosis of COVID-19 in hospitalized patients.
Methods: We evaluated 499 hospitalized patients with confirmed COVID-19, without a history of chronic kidney disease. The patients' demographic data, laboratory values, and outcomes were retrospectively collected from the hospital information system. Serumelectrolytes including sodium, potassium, magnesium, calcium, and phosphorus abnormalities were analyzed on admission and during the hospitalization period. The outcomes of this study were the occurrence of acute kidney injury (AKI) after the first week of hospitalization and in-hospital mortality rate. Multivariate analyses were carried out to obtain the independent risk of each EI on mortality, by adjusting for age, gender, and AKI occurrence.
Results: Among the 499 COVID-19 patients (60.9% male), AKI occurred in 168 (33.7%) and mortality in 92 (18.4%) cases. Hypocalcemia (38%) and hyponatremia (22.6%) were the most prevalent EIs, and all EIs were more common in the AKI group than in the non-AKI group. Hyponatremia (Adjusted Odds ratio [AOR] = 2.34, 95% CI: 1.30 to 4.18), hypernatremia (AOR = 8.52, 95% CI: 1.95 to 37.32), and hyperkalemia (AOR = 4.63, 95% CI: 1.65 to 13) on admission were associated with poor prognosis. Moreover, hyponatremia (AOR = 3.02, 95% CI: 1.28 to 7.15) and hyperphosphatemia (AOR = 5.12, 95% CI: 1.24 to 21.09) on admission were associated with late AKI occurrence.
Conclusion: This study highlights the role of hyponatremia, hypernatremia, hyperkalemia, and hyperphosphatemia in poor prognosis of COVID-19. According to the independent effect of EI on late AKI and mortality, we recommend physicians to raise awareness to closely monitor and correct EI during hospitalization. DOI: 10.52547/ijkd.6904.
Introduction: The aim of this study was to investigate the expression of aquaporin 1 (AQP-1), AQP-3 and vascular endothelial growth factor A (VEGF-A) in peritoneal tissues of patients without kidney disease, chronic kidney disease at stages 5 (CKD 5) and patients on prolonged peritoneal dialysis with ultrafiltration failure (PDUFF), and elucidate the possible mechanism of peritoneal dialysis ultrafiltration failure.
Methods: Peritoneal specimens were collected from the following patient groups at Xianju People's hospital: CKD 5, PD-UFF and normal control groups. Routine staining and immunohistochemical analyses were performed on samples obtained from the three groups.
Results: The expression of AQP-1 and AQP-3 on peritoneal mesothelial cells, peritoneal vessels and in the interstitium was significantly lower in the PD-UFF group than the CKD 5 and control groups (P < .01), while no statistically significant difference was found between the CKD 5 and control groups (P > .05). In contrast, VEGF-A expression was significantly higher in peritoneal mesothelial cells, peritoneal vessels and the interstitium in the PD-UFF group than the CKD 5 and control groups (P < .01). No statistically significant difference was found between the CKD 5 and control groups (P > .05).
Conclusion: AQP-1 and AQP-3 expression levels decrease in peritoneal mesothelial cells and the vascular interstitium of patients with a prolonged peritoneal dialysis course, while VEGF-A expression gradually increases. The formation of peritoneal neovascularization and the decrease in AQP expression may be primarily associated with peritoneal dialysis ultrafiltration failure. DOI: 10.52547/ijkd.6928.
Chronic kidney disease is a public health problem. The purpose of this study was to compare the effects of sevelamer and calciumbased binders on mortality of hemodialysis patients. PubMed, EMBASE and Web of Science were searched for related articles published before May 14, 2020. We included six studies with 43330 participants, of which 21147 and 22183 received calciumbased phosphate binders and sevelamer, respectively. In the analysis of unadjusted data, sevelamer could lower cardiovascular mortality. When adjusted HRs was pooled, the cardiovascular mortality did not differ significantly in the sevelamer and calcium-based phosphate binders groups. Additionally, the all-cause mortality rate in sevelamer group was different from that in calcium-based phosphate binders group. However, sevelamer could not lower all-cause mortality in terms of the adjusted data. No significant difference was found in calcium and phosphorus between calcium-based phosphate binders and sevalmer. Sensitivity analysis showed that partial results of the study were inconsistent. There was no difference in the effect of sevelamer and calciumbased phosphate binders on the risk of all-cause mortality in patients with hemodialysis, after adjusting confounders. However, given the instability of the results, the results need to be further confirmed by a large sample and high quality RCTs. DOI: 10.52547/ijkd.6814.
Introduction: Kidney biopsy is a procedure of choice for the diagnosis of many kidney diseases. In children it is performed with the use of sedatives. The aim of this study was to compare the combination of propofol/fentanyl with midazolam/ketamine for sedation in pediatric patients undergoing kidney biopsy.
Methods: In this double-blinded clinical trial, seventeen children, candidate of kidney biopsy were included and randomized into two groups. One group received Midazolam/Ketamine with doses of 30 to 50 μg/kg and 0.25 to 1 mg/kg, and the other group were sedated with propofol/fentanyl combination in doses of 0.5 to 1 mg/kg and 0.5 to 1 mg/kg, respectively. Administration time, medication doses, total procedure time, need for analgesic use after the procedure, and patient relaxation, with no agitation during and after the biopsy were recorded.
Results: Nine patients received midazolam/ketamine and eight received propofol/fentanyl. None of them experienced vomiting or itching after sedation. There were no meaningful differences in qualitative variables of the need for pain relief between two groups. Regarding the distribution of pain at the time of sedation, and 1, 3, 6, and 24 hours after sedation, there was no significant statistical difference between the two groups. There was also no significant statistical difference between the two groups, regarding patients' relaxation during, and 1, 3, 6, and 24 hours after biopsy.
Conclusion: There was no statistically significant difference between the degree of sedation and the analgesic effect of the two regimens in the two groups. DOI: 10.52547/ijkd.6982.
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