Pub Date : 2022-09-14DOI: 10.5812/numonthly-128158
Azita Zafar Mohtashami, B. Hadian, Narges Izadi Meidarsofla
Background: Chronic kidney disease, a global health problem, leads to end-stage kidney disease, whose treatment requires long-term renal replacement therapy. The incidence of hemodialysis patients with end-stage kidney disease is increasing worldwide. The survival rate of hemodialysis patients is crucial for decision-making and planning. Objectives: This study aimed to determine the survival rate of hemodialysis patients and its related factors using the competing risk analysis approach to acquire more precise estimations of survival and mortality of the patients. Methods: This study was primarily based on medical records of hemodialysis patients who started dialysis from January 2011 to December 2017. The end of the study follow-up period was December 2021. The study included 214 eligible patients. Death was regarded as the event of interest, kidney transplantation as the competing risk, and other consequences as censored. We analyzed the data by cumulative incidence functions, Gray’s test, and Fine-Gray regression model using R version 4.1.2 and Stata v.16 at a significance level of 0.05. Results: The median age at the initiation of hemodialysis was 60 years. The risks of death in the first, second, third, fourth, and fifth years were 18.3%, 31.7%, 41.6%, 49.9%, and 60.9%, respectively. In the regression model, age at the initiation of hemodialysis (P-value = 0.000) and education (P-value = 0.000) were associated with mortality. Conclusions: Competing risk estimates of survival analysis of hemodialysis patients are more reliable than conventional approaches (e.g., Kaplan–Meier estimator) for planning and improving interventions and allocating resources. Detection of patients at a younger age and increasing patients' knowledge plays a significant role in improving their survival.
背景:慢性肾脏疾病是一个全球性的健康问题，可导致终末期肾脏疾病，其治疗需要长期肾脏替代治疗。终末期肾病血液透析患者的发病率在世界范围内呈上升趋势。血液透析患者的存活率对决策和计划至关重要。目的:本研究旨在采用竞争风险分析方法确定血液透析患者的生存率及其相关因素，以更准确地估计患者的生存和死亡率。方法:本研究主要基于2011年1月至2017年12月开始透析的血液透析患者的医疗记录。研究随访期于2021年12月结束。该研究包括214名符合条件的患者。死亡被视为值得关注的事件，肾移植被视为竞争风险，其他后果被审查。我们采用累积关联函数、Gray检验和Fine-Gray回归模型对数据进行分析，使用R version 4.1.2和Stata v.16，显著性水平为0.05。结果:开始血液透析的中位年龄为60岁。第一、二、三、四、五年的死亡风险分别为18.3%、31.7%、41.6%、49.9%和60.9%。在回归模型中，开始血液透析的年龄(p值= 0.000)和教育程度(p值= 0.000)与死亡率相关。结论:血液透析患者生存分析的竞争风险估计比传统方法(例如Kaplan-Meier估计)在计划和改进干预措施和分配资源方面更可靠。在更年轻的年龄发现患者并增加患者的知识对提高患者的生存率具有重要作用。
{"title":"Survival Rate of Hemodialysis Patients: A Competing Risk Analysis Approach","authors":"Azita Zafar Mohtashami, B. Hadian, Narges Izadi Meidarsofla","doi":"10.5812/numonthly-128158","DOIUrl":"https://doi.org/10.5812/numonthly-128158","url":null,"abstract":"Background: Chronic kidney disease, a global health problem, leads to end-stage kidney disease, whose treatment requires long-term renal replacement therapy. The incidence of hemodialysis patients with end-stage kidney disease is increasing worldwide. The survival rate of hemodialysis patients is crucial for decision-making and planning. Objectives: This study aimed to determine the survival rate of hemodialysis patients and its related factors using the competing risk analysis approach to acquire more precise estimations of survival and mortality of the patients. Methods: This study was primarily based on medical records of hemodialysis patients who started dialysis from January 2011 to December 2017. The end of the study follow-up period was December 2021. The study included 214 eligible patients. Death was regarded as the event of interest, kidney transplantation as the competing risk, and other consequences as censored. We analyzed the data by cumulative incidence functions, Gray’s test, and Fine-Gray regression model using R version 4.1.2 and Stata v.16 at a significance level of 0.05. Results: The median age at the initiation of hemodialysis was 60 years. The risks of death in the first, second, third, fourth, and fifth years were 18.3%, 31.7%, 41.6%, 49.9%, and 60.9%, respectively. In the regression model, age at the initiation of hemodialysis (P-value = 0.000) and education (P-value = 0.000) were associated with mortality. Conclusions: Competing risk estimates of survival analysis of hemodialysis patients are more reliable than conventional approaches (e.g., Kaplan–Meier estimator) for planning and improving interventions and allocating resources. Detection of patients at a younger age and increasing patients' knowledge plays a significant role in improving their survival.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43865766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-13DOI: 10.5812/numonthly-126633
Farhood Khaleghi mehr, M. Abolhasani, Yasin Zakeri
Introduction: Primary retroperitoneal mature cystic teratomas (PRPMCT) are uncommon in adults. They typically occur in infants under six months old and young females. So far, some limited case reports have been documented in the literature. This case report presents a rare case of an adult patient with PRPMCT aged over 30 years. Case Presentation: The patient was a 34-year-old female with PRPMCT in the site of the left adrenal gland and abdominal discomfort. Computed tomography (CT) scan revealed a 66 mm hypodense lesion with fat attenuation and calcification in the left retroperitoneum. Laparotomy with resection of the retroperitoneal (RP) lesion was done. Gross examination showed a solid multicystic mass measuring 8x6.5x6 cm. Histopathologic examination revealed a neoplastic tissue composed of mature osseous and cartilaginous tissue associated with stratified squamous epithelium and lumens lined by ciliated columnar epithelium, and the diagnosis was mature cystic teratoma. The patient had an uncomplicated postoperative course without recurrence after seven months of follow-up. Conclusions: PRPMCT in adults is extremely rare. RP metastasis of primary gonadal teratoma and non-functioning adrenal tumors should be excluded first. Due to the diagnostic difficulty of posterior peritoneal teratoma with radiological imaging and its risk of malignancy, surgical resection would be the most effective diagnostic and therapeutic option. Complete resection of the mass is important to judge the existence of immature and solid components that require a long-time follow-up because of the increased risk of malignancy.
{"title":"Primary Mature Cystic Teratoma of the Retroperitoneum Presenting as a Suprarenal Mass in an Adult Patient: A Case Report","authors":"Farhood Khaleghi mehr, M. Abolhasani, Yasin Zakeri","doi":"10.5812/numonthly-126633","DOIUrl":"https://doi.org/10.5812/numonthly-126633","url":null,"abstract":"Introduction: Primary retroperitoneal mature cystic teratomas (PRPMCT) are uncommon in adults. They typically occur in infants under six months old and young females. So far, some limited case reports have been documented in the literature. This case report presents a rare case of an adult patient with PRPMCT aged over 30 years. Case Presentation: The patient was a 34-year-old female with PRPMCT in the site of the left adrenal gland and abdominal discomfort. Computed tomography (CT) scan revealed a 66 mm hypodense lesion with fat attenuation and calcification in the left retroperitoneum. Laparotomy with resection of the retroperitoneal (RP) lesion was done. Gross examination showed a solid multicystic mass measuring 8x6.5x6 cm. Histopathologic examination revealed a neoplastic tissue composed of mature osseous and cartilaginous tissue associated with stratified squamous epithelium and lumens lined by ciliated columnar epithelium, and the diagnosis was mature cystic teratoma. The patient had an uncomplicated postoperative course without recurrence after seven months of follow-up. Conclusions: PRPMCT in adults is extremely rare. RP metastasis of primary gonadal teratoma and non-functioning adrenal tumors should be excluded first. Due to the diagnostic difficulty of posterior peritoneal teratoma with radiological imaging and its risk of malignancy, surgical resection would be the most effective diagnostic and therapeutic option. Complete resection of the mass is important to judge the existence of immature and solid components that require a long-time follow-up because of the increased risk of malignancy.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46565594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-26DOI: 10.5812/numonthly-127290
Z. Rostami, Farzaneh Futuhi, E. Nemati, Azam Soleimani Najafabadi, M. Javanbakht, M. Ebrahimi, Bentolhoda Beyram, B. Einollahi
Background: Despite all of the research on the risk factors for severe COVID-19, there are still many unknowns about the course of COVID-19 in various populations. Inevitable exposure of dialysis patients, one of the more vulnerable groups for infectious diseases, to COVID-19 concerns many researchers. Furthermore, studies on the mortality rate and risk factors regarding dialysis patients are somewhat inconsistent. Also, it has been suggested that factors such as ethnicity can contribute to that matter. Objectives: We aimed to evaluate the mortality rate of dialysis patients who contracted COVID-19 in the Iranian population. Methods: In this cross-sectional study, we presented the experiences of 4 dialysis centers with a total of 309 dialysis patients (Tehran, Iran) during the COVID-19 pandemic to assess the mortality rate and associated risk factors. Results: Among 309 dialysis patients, 58 patients contracted the disease, and the total mortality rate in this study was 41%. It was observed that although the guidelines for screening patients were similar in these 4 centers, the centers with regular COVID-19 screening for staff members had much lower mortality and infection rate. The most common symptoms in patients were fever, dry cough, and chills. Furthermore, comorbidities such as diabetes can also increase the risk of mortality. Conclusions: This study, along with other studies, can be utilized in developing guidelines for dialysis centers in the COVID-19 pandemic and future pandemics.
{"title":"Dialysis During the COVID-19 Pandemic: Experiences from 4 Dialysis Centers in Iran","authors":"Z. Rostami, Farzaneh Futuhi, E. Nemati, Azam Soleimani Najafabadi, M. Javanbakht, M. Ebrahimi, Bentolhoda Beyram, B. Einollahi","doi":"10.5812/numonthly-127290","DOIUrl":"https://doi.org/10.5812/numonthly-127290","url":null,"abstract":"Background: Despite all of the research on the risk factors for severe COVID-19, there are still many unknowns about the course of COVID-19 in various populations. Inevitable exposure of dialysis patients, one of the more vulnerable groups for infectious diseases, to COVID-19 concerns many researchers. Furthermore, studies on the mortality rate and risk factors regarding dialysis patients are somewhat inconsistent. Also, it has been suggested that factors such as ethnicity can contribute to that matter. Objectives: We aimed to evaluate the mortality rate of dialysis patients who contracted COVID-19 in the Iranian population. Methods: In this cross-sectional study, we presented the experiences of 4 dialysis centers with a total of 309 dialysis patients (Tehran, Iran) during the COVID-19 pandemic to assess the mortality rate and associated risk factors. Results: Among 309 dialysis patients, 58 patients contracted the disease, and the total mortality rate in this study was 41%. It was observed that although the guidelines for screening patients were similar in these 4 centers, the centers with regular COVID-19 screening for staff members had much lower mortality and infection rate. The most common symptoms in patients were fever, dry cough, and chills. Furthermore, comorbidities such as diabetes can also increase the risk of mortality. Conclusions: This study, along with other studies, can be utilized in developing guidelines for dialysis centers in the COVID-19 pandemic and future pandemics.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46515196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-13DOI: 10.5812/numonthly-128085
M. Miri, Shaghayegh Badriahmadi, A. Shamshirian, AmirAli Moodi Ghalibaf, Mahnaz Mozdourian
Background: Various risk factors have been proposed for severe coronavirus disease 2019 (COVID-19); nonetheless, the prognostic role of serum electrolytes has not been widely studied. Objectives: The present study aimed to identify the potential prognostic role of electrolyte imbalance in hospitalized COVID-19 patients. Methods: This retrospective study was conducted in Imam Reza Hospital, Mashhad, Iran. The medical records of all COVID-19 patients admitted to the emergency department from May to August 2020 were evaluated. Demographic data and clinical findings upon admission were collected. Disease severity, lung involvement severity on imaging, inflammatory serum biomarkers, admission to the intensive care unit, and serum levels of sodium, potassium, magnesium, calcium (corrected by serum albumin level), and phosphorus were documented. Results: Most patients (60%) were male, and the mean age of the total population was 58.87 ± 1.82 years. Severe COVID-19 was detected in most cases (94.9%) who were significantly older (P = 0.037), had hypertension (P = 0.032), ischemic heart disease (P = 0.033), and higher serum urea (P = 0.001) and serum potassium (P < 0.001). Patients with poor prognosis based on computed tomography (CT) scores had significantly higher serum urea (P = 0.002) and magnesium (P = 0.035) than patients with good prognosis, while serum calcium was significantly higher in the latter group (P = 0.007). Furthermore, there was a significant relationship between COVID-19 severity and serum potassium (P < 0.001). Conclusions: Abnormal serum electrolytes are correlated with COVID-19 severity. Moreover, serum potassium level is a predictor of severe disease.
{"title":"Electrolyte Imbalance and COVID-19 Severity in Hospitalized Patients","authors":"M. Miri, Shaghayegh Badriahmadi, A. Shamshirian, AmirAli Moodi Ghalibaf, Mahnaz Mozdourian","doi":"10.5812/numonthly-128085","DOIUrl":"https://doi.org/10.5812/numonthly-128085","url":null,"abstract":"Background: Various risk factors have been proposed for severe coronavirus disease 2019 (COVID-19); nonetheless, the prognostic role of serum electrolytes has not been widely studied. Objectives: The present study aimed to identify the potential prognostic role of electrolyte imbalance in hospitalized COVID-19 patients. Methods: This retrospective study was conducted in Imam Reza Hospital, Mashhad, Iran. The medical records of all COVID-19 patients admitted to the emergency department from May to August 2020 were evaluated. Demographic data and clinical findings upon admission were collected. Disease severity, lung involvement severity on imaging, inflammatory serum biomarkers, admission to the intensive care unit, and serum levels of sodium, potassium, magnesium, calcium (corrected by serum albumin level), and phosphorus were documented. Results: Most patients (60%) were male, and the mean age of the total population was 58.87 ± 1.82 years. Severe COVID-19 was detected in most cases (94.9%) who were significantly older (P = 0.037), had hypertension (P = 0.032), ischemic heart disease (P = 0.033), and higher serum urea (P = 0.001) and serum potassium (P < 0.001). Patients with poor prognosis based on computed tomography (CT) scores had significantly higher serum urea (P = 0.002) and magnesium (P = 0.035) than patients with good prognosis, while serum calcium was significantly higher in the latter group (P = 0.007). Furthermore, there was a significant relationship between COVID-19 severity and serum potassium (P < 0.001). Conclusions: Abnormal serum electrolytes are correlated with COVID-19 severity. Moreover, serum potassium level is a predictor of severe disease.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41618038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-12DOI: 10.5812/numonthly-120721
H. Verma, S. Sunder, B. Sharma, N. Sharma, Rashi Verma
Background: Calcium-based and non-calcium-based phosphate binders are frequently used to treat hyperphosphatemia in patients with chronic kidney disease (CKD). Objectives: This study aimed to compare the effects of calcium acetate and sevelamer carbonate on the progression of aortic vascular calcification in patients with CKD stages 4 and 5. Methods: This was an open-label randomized prospective comparative study, in which the participants encompassed both male and female patients with ambulatory hyperphosphatemic CKD stages 4 and 5 aged above 18 years. One hundred fifty patients with CKD stages 4 and 5 were screened for Aortic vascular calcification using digital X-ray lumbar spine and multi-slice CT scan, of whom fifty patients with vascular calcification were selected and randomly assigned into two groups. The participants were then serially studied for the effects of phosphate binders on the progression of vascular calcification over one year. One group was prescribed calcium acetate, and the other group was prescribed sevelamer carbonate. Results: Fifty hyperphosphatemic CKD patients with a mean age of 57 years were randomly assigned into two groups. There was no statistically significant difference between the two groups; however, the patients assigned to the sevelamer group were older and higher aortic calcification index (ACI) (P = 0.035) and Kauppila scores (P = 0.04), and elevated serum calcium (P = 0.04), Ca X PO4 (P = 0.006), and vitamin D. In calcium acetate-treated patients, the mean ACI increased significantly during six months and one year; however, the increase was not significant in the sevelamer group. Serum cholesterol, serum triglycerides, serum iPTH level, and the inflammatory markers of atherosclerosis high sensitivity of C-reactive protein (hs-CRP), interleukin-6 (IL-6) (hs-CRP, IL-6) decreased significantly in the sevelamer group. Conclusions: The prevalence of vascular (abdominal aortic) calcification in pre-ESRD (CKD stage 4 and 5) patients was 75%. Abdominal aortic calcification increased significantly in calcium acetate-treated patients during six months and one year; however, the progression was not significant regarding sevelamer. Because of its pleiotropic properties, sevelamer is more effective and consistent in retarding the progression of vascular calcification than calcium acetate in patients with CKD stages 4 and 5.
{"title":"A Comparison Between the Effects of Calcium Acetate and Sevelamer Carbonate on Progression of Aortic Vascular Calcification in Patients with Chronic Kidney Disease Stages 4 and 5","authors":"H. Verma, S. Sunder, B. Sharma, N. Sharma, Rashi Verma","doi":"10.5812/numonthly-120721","DOIUrl":"https://doi.org/10.5812/numonthly-120721","url":null,"abstract":"Background: Calcium-based and non-calcium-based phosphate binders are frequently used to treat hyperphosphatemia in patients with chronic kidney disease (CKD). Objectives: This study aimed to compare the effects of calcium acetate and sevelamer carbonate on the progression of aortic vascular calcification in patients with CKD stages 4 and 5. Methods: This was an open-label randomized prospective comparative study, in which the participants encompassed both male and female patients with ambulatory hyperphosphatemic CKD stages 4 and 5 aged above 18 years. One hundred fifty patients with CKD stages 4 and 5 were screened for Aortic vascular calcification using digital X-ray lumbar spine and multi-slice CT scan, of whom fifty patients with vascular calcification were selected and randomly assigned into two groups. The participants were then serially studied for the effects of phosphate binders on the progression of vascular calcification over one year. One group was prescribed calcium acetate, and the other group was prescribed sevelamer carbonate. Results: Fifty hyperphosphatemic CKD patients with a mean age of 57 years were randomly assigned into two groups. There was no statistically significant difference between the two groups; however, the patients assigned to the sevelamer group were older and higher aortic calcification index (ACI) (P = 0.035) and Kauppila scores (P = 0.04), and elevated serum calcium (P = 0.04), Ca X PO4 (P = 0.006), and vitamin D. In calcium acetate-treated patients, the mean ACI increased significantly during six months and one year; however, the increase was not significant in the sevelamer group. Serum cholesterol, serum triglycerides, serum iPTH level, and the inflammatory markers of atherosclerosis high sensitivity of C-reactive protein (hs-CRP), interleukin-6 (IL-6) (hs-CRP, IL-6) decreased significantly in the sevelamer group. Conclusions: The prevalence of vascular (abdominal aortic) calcification in pre-ESRD (CKD stage 4 and 5) patients was 75%. Abdominal aortic calcification increased significantly in calcium acetate-treated patients during six months and one year; however, the progression was not significant regarding sevelamer. Because of its pleiotropic properties, sevelamer is more effective and consistent in retarding the progression of vascular calcification than calcium acetate in patients with CKD stages 4 and 5.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41587929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-27DOI: 10.5812/numonthly-126626
E. Valavi, A. Nickavar, Parisa Amoori, Sadrodin Raiszadeh
Background: Hyponatremia/water intoxication has been considered a rare but serious complication of desmopressin (DDAVP) for the treatment of primary monosymptomatic nocturnal enuresis (PMNE). Objectives: This study aimed to identify the incidence and risk factors of serum sodium (Na) alterations in children with PMNE treated with oral or intranasal DDAVP. Methods: A total of 201 patients with PMNE were evaluated in 2 groups using intranasal (n = 127) or oral DDAVP (n = 74) for approximately 6 months. Treatment efficacy was defined as a more than 50% decrease in wet nights after 1 month of treatment. Serum Na was measured before, during, and after treatment in all patients. Predisposing factors of serum Na disturbance were evaluated concomitantly. Results: The mean age of patients was 8.8 ± 2.6 (5 - 17.5) years, and males outnumbered females (M/F = 1.68). Treatment efficacy was 100% in 93 (46.2%), and > 90% in 157 (78.1%) cases. Oral DDAVP had significantly more therapeutic effects than intranasal treatment (P = 0.024). However, serum Na had no significant difference between the 2 groups (P = 0.52). Hyponatremia occurred in 7 (3.5%) patients (3 in oral treatment and 4 in intranasal treatment; P = 0.73) with no significant correlation to age, gender, body weight, frequency of enuresis, and initial serum Na. However, decreased serum Na > 5 mEq/L was a significant risk factor for the prediction of hyponatremia in our patients (P < 0.001). Conclusions: Oral DDAVP had more therapeutic effects than intranasal treatment for the treatment of PMNE. Serum Na had no significant alteration in both oral and intranasal treatments, and hyponatremia was a rare complication of DDAVP, which occurred significantly in children with a > 5-mEq/L decrease of initial serum Na concentration. As a suggestion, monitoring serum Na is not an essential follow-up in asymptomatic patients in DDAVP treatment.
{"title":"Serum Sodium Alterations in Children with Primary Monosymptomatic Nocturnal Enuresis Using Desmopressin","authors":"E. Valavi, A. Nickavar, Parisa Amoori, Sadrodin Raiszadeh","doi":"10.5812/numonthly-126626","DOIUrl":"https://doi.org/10.5812/numonthly-126626","url":null,"abstract":"Background: Hyponatremia/water intoxication has been considered a rare but serious complication of desmopressin (DDAVP) for the treatment of primary monosymptomatic nocturnal enuresis (PMNE). Objectives: This study aimed to identify the incidence and risk factors of serum sodium (Na) alterations in children with PMNE treated with oral or intranasal DDAVP. Methods: A total of 201 patients with PMNE were evaluated in 2 groups using intranasal (n = 127) or oral DDAVP (n = 74) for approximately 6 months. Treatment efficacy was defined as a more than 50% decrease in wet nights after 1 month of treatment. Serum Na was measured before, during, and after treatment in all patients. Predisposing factors of serum Na disturbance were evaluated concomitantly. Results: The mean age of patients was 8.8 ± 2.6 (5 - 17.5) years, and males outnumbered females (M/F = 1.68). Treatment efficacy was 100% in 93 (46.2%), and > 90% in 157 (78.1%) cases. Oral DDAVP had significantly more therapeutic effects than intranasal treatment (P = 0.024). However, serum Na had no significant difference between the 2 groups (P = 0.52). Hyponatremia occurred in 7 (3.5%) patients (3 in oral treatment and 4 in intranasal treatment; P = 0.73) with no significant correlation to age, gender, body weight, frequency of enuresis, and initial serum Na. However, decreased serum Na > 5 mEq/L was a significant risk factor for the prediction of hyponatremia in our patients (P < 0.001). Conclusions: Oral DDAVP had more therapeutic effects than intranasal treatment for the treatment of PMNE. Serum Na had no significant alteration in both oral and intranasal treatments, and hyponatremia was a rare complication of DDAVP, which occurred significantly in children with a > 5-mEq/L decrease of initial serum Na concentration. As a suggestion, monitoring serum Na is not an essential follow-up in asymptomatic patients in DDAVP treatment.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43491231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-22DOI: 10.5812/numonthly-116629
Vida Sarmadi, Sahar Vahdat, S. Shahidi, A. Atapour, S. Hosseini
Background: End-stage renal disease (ESRD) needs replacement therapy and most often, kidney transplantation is the best therapeutic option. Urinary tract infection (UTI) is one of the most important complications after renal transplantation that affects transplantation outcomes. Objectives: This study aimed to define the incidence rate, UTI risk factors among kidney transplant recipients, and causative organism of UTI and their antibiotic susceptibility. Methods: In this cross-sectional study, we collected clinical, demographic, and laboratory data from 268 transplant recipients in Ali-Asghar Hospital from 2011 - 2018. Data collected from patients were analyzed with SPSS software version 25. Results: According to the results, 50 (18.7%) had UTI in the first year after renal transplantation. Female gender and underlying cause of renal failure were predisposing factors for UTI. The most common causative organism was Escherichia coli (58.4%). The antibiotic susceptibility results showed nitrofurantoin and meropenem as the most effective antibiotics for Escherichia coli. Conclusions: The UTI was more common in women and patients with analgesic nephropathy and lupus nephritis. The most common causative organism was E. coli and meropenem and nitrofurantoin were the most effective drug choices.
{"title":"The Prevalence and Risk Factors for Urinary Tract Infection in Kidney Transplant Recipients in the First Year After Transplantation","authors":"Vida Sarmadi, Sahar Vahdat, S. Shahidi, A. Atapour, S. Hosseini","doi":"10.5812/numonthly-116629","DOIUrl":"https://doi.org/10.5812/numonthly-116629","url":null,"abstract":"Background: End-stage renal disease (ESRD) needs replacement therapy and most often, kidney transplantation is the best therapeutic option. Urinary tract infection (UTI) is one of the most important complications after renal transplantation that affects transplantation outcomes. Objectives: This study aimed to define the incidence rate, UTI risk factors among kidney transplant recipients, and causative organism of UTI and their antibiotic susceptibility. Methods: In this cross-sectional study, we collected clinical, demographic, and laboratory data from 268 transplant recipients in Ali-Asghar Hospital from 2011 - 2018. Data collected from patients were analyzed with SPSS software version 25. Results: According to the results, 50 (18.7%) had UTI in the first year after renal transplantation. Female gender and underlying cause of renal failure were predisposing factors for UTI. The most common causative organism was Escherichia coli (58.4%). The antibiotic susceptibility results showed nitrofurantoin and meropenem as the most effective antibiotics for Escherichia coli. Conclusions: The UTI was more common in women and patients with analgesic nephropathy and lupus nephritis. The most common causative organism was E. coli and meropenem and nitrofurantoin were the most effective drug choices.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43428661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-22DOI: 10.5812/numonthly-124164
Rajaram Jagdale, Alan Almeida, J. Kothari, R. Sirsat, Supriya Surwase, Dixon Thomas
Background: Hemodialysis among critical care patients with acute kidney injury (AKI) is challenging, especially if heparin is contraindicated. Objectives: This study assessed the utility of citrate dialysis for such patients in a limited-resource setting. Methods: In this prospective study, patients were divided into group A (heparin-free saline flush dialysis), group B (heparin-free citrate dialysis without flushing), and group C (heparin-free citrate dialysis with flushing). The subjects underwent completed sustained low-efficiency daily dialysis (blood flow = 150 mL/minute, dialysate = 300 mL/minute) or intermittent hemodialysis (blood flow = 250 mL/minute, dialysate flow = 500 mL/minute). Statistical tests using SPSS software (version 26) were used to determine safety and effectiveness differences. Results: Among 25 patients studied with multiple hemodialysis sessions, blood flow and dialysate flow were observed to be better in heparin-free citrate dialysis with flushing. There were further advantages of lesser dialyzer clotting and more reuse of dialyzers. Metabolic differences were insignificant. Heparin-free citrate dialysis with or without flushing was equally effective and safe, compared to heparin-free saline flush dialysis, in patients with or without liver impairment. Conclusions: Citrate dialysis is observed to be a safe and effective alternative to heparin-free saline flushing dialysis in intensive care unit patients with AKI. More such studies are required in limited-resource settings to utilize citrate dialysis in patients with heparin contraindication.
{"title":"Utility of Citrate Dialysis in Patients with Contraindication for Heparin in a Limited-Resource Setting","authors":"Rajaram Jagdale, Alan Almeida, J. Kothari, R. Sirsat, Supriya Surwase, Dixon Thomas","doi":"10.5812/numonthly-124164","DOIUrl":"https://doi.org/10.5812/numonthly-124164","url":null,"abstract":"Background: Hemodialysis among critical care patients with acute kidney injury (AKI) is challenging, especially if heparin is contraindicated. Objectives: This study assessed the utility of citrate dialysis for such patients in a limited-resource setting. Methods: In this prospective study, patients were divided into group A (heparin-free saline flush dialysis), group B (heparin-free citrate dialysis without flushing), and group C (heparin-free citrate dialysis with flushing). The subjects underwent completed sustained low-efficiency daily dialysis (blood flow = 150 mL/minute, dialysate = 300 mL/minute) or intermittent hemodialysis (blood flow = 250 mL/minute, dialysate flow = 500 mL/minute). Statistical tests using SPSS software (version 26) were used to determine safety and effectiveness differences. Results: Among 25 patients studied with multiple hemodialysis sessions, blood flow and dialysate flow were observed to be better in heparin-free citrate dialysis with flushing. There were further advantages of lesser dialyzer clotting and more reuse of dialyzers. Metabolic differences were insignificant. Heparin-free citrate dialysis with or without flushing was equally effective and safe, compared to heparin-free saline flush dialysis, in patients with or without liver impairment. Conclusions: Citrate dialysis is observed to be a safe and effective alternative to heparin-free saline flushing dialysis in intensive care unit patients with AKI. More such studies are required in limited-resource settings to utilize citrate dialysis in patients with heparin contraindication.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45448850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.5812/numonthly-127124
Elham Ramezanzade, Reyhane Ghanbari, Tina Yazdanipour
Introduction: Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) is a group of multisystemic autoimmune diseases that can involve organs such as kidneys and respiratory tracts. Since the initiation of COVID-19 vaccines, there have been few cases of antineutrophil cytoplasmic antibody (ANCA) glomerulonephritis development after receiving vaccine doses. Case Presentation: This report describes a 15-year-old man who has developed ANCA-associated glomerulonephritis (AAGN) after receiving the second dose of BBIBP-CorV (Sinopharm) COVID-19 vaccine. Conclusions: Development of AAGN after both natural SARS-CoV-2 infection and following other vaccinations raises the question of the possible causality between the two. Considering the widespread use of COVID-19 vaccines, it is highly important to investigate their possible side effects.
{"title":"Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Glomerulonephritis in a 15-year-old Patient After Receiving the Second Dose of the BBIBP-CorV (Sinopharm) COVID-19 Vaccine: A Case Report","authors":"Elham Ramezanzade, Reyhane Ghanbari, Tina Yazdanipour","doi":"10.5812/numonthly-127124","DOIUrl":"https://doi.org/10.5812/numonthly-127124","url":null,"abstract":"Introduction: Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) is a group of multisystemic autoimmune diseases that can involve organs such as kidneys and respiratory tracts. Since the initiation of COVID-19 vaccines, there have been few cases of antineutrophil cytoplasmic antibody (ANCA) glomerulonephritis development after receiving vaccine doses. Case Presentation: This report describes a 15-year-old man who has developed ANCA-associated glomerulonephritis (AAGN) after receiving the second dose of BBIBP-CorV (Sinopharm) COVID-19 vaccine. Conclusions: Development of AAGN after both natural SARS-CoV-2 infection and following other vaccinations raises the question of the possible causality between the two. Considering the widespread use of COVID-19 vaccines, it is highly important to investigate their possible side effects.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41748328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-25DOI: 10.5812/numonthly-123956
Farzane Moradi Shamami, P. Yousefichaijan, M. Hashemi, F. Dorreh, A. Arjmand, Saeed Karimi Matloub, M. Rezagholizamenjany
Background: Gastroenteritis, as a rare and heterogeneous condition, is characterized by patchy or diffuse infiltration of gastrointestinal tissue. Induced azotemia in humans following gastroenteritis has been evaluated in some studies. Objectives: The aim of the present study was to evaluate the effect of montelukast on induced azotemia in humans following gastroenteritis. Methods: This study examined children with gastroenteritis with moderate dehydration and more than 3 years of age. The cases had a glomerular filtration rate (GFR) of less than 90 and were evaluated in 2 groups of control (n = 20) and intervention (n = 20). Montelukast (5-mg tablets) was given to patients in the intervention group for 5 days. Normal saline at a rate of 20 cc/kg was given to both groups within 20 minutes until clinical symptoms improved. Finally, the improvement of renal function was evaluated and compared between the 2 groups using SPSS. Results: Out of 40 evaluated patients, the mean age of the control and intervention groups was 5.52 and 5.15 years, respectively. Also, 13 cases (65.0%) in the control group and 9 cases (45.0%) in the control group were males. The mean creatinine (Cr) was significantly reduced after treatment in the intervention group (P = 0.001). Also, the mean GFR after treatment was significantly higher in the intervention group (P = 0.001), and GFR improvement duration was significantly lower in the intervention group (P = 0.002). Conclusions: Montelukast as an add-on drug was effective in reducing the time of GFR enhancement; thus, we can consider it as an add-on drug in azotemia.
{"title":"Montelukast as an Add-On Drug in Induced Azotemia in Humans Following Gastroenteritis","authors":"Farzane Moradi Shamami, P. Yousefichaijan, M. Hashemi, F. Dorreh, A. Arjmand, Saeed Karimi Matloub, M. Rezagholizamenjany","doi":"10.5812/numonthly-123956","DOIUrl":"https://doi.org/10.5812/numonthly-123956","url":null,"abstract":"Background: Gastroenteritis, as a rare and heterogeneous condition, is characterized by patchy or diffuse infiltration of gastrointestinal tissue. Induced azotemia in humans following gastroenteritis has been evaluated in some studies. Objectives: The aim of the present study was to evaluate the effect of montelukast on induced azotemia in humans following gastroenteritis. Methods: This study examined children with gastroenteritis with moderate dehydration and more than 3 years of age. The cases had a glomerular filtration rate (GFR) of less than 90 and were evaluated in 2 groups of control (n = 20) and intervention (n = 20). Montelukast (5-mg tablets) was given to patients in the intervention group for 5 days. Normal saline at a rate of 20 cc/kg was given to both groups within 20 minutes until clinical symptoms improved. Finally, the improvement of renal function was evaluated and compared between the 2 groups using SPSS. Results: Out of 40 evaluated patients, the mean age of the control and intervention groups was 5.52 and 5.15 years, respectively. Also, 13 cases (65.0%) in the control group and 9 cases (45.0%) in the control group were males. The mean creatinine (Cr) was significantly reduced after treatment in the intervention group (P = 0.001). Also, the mean GFR after treatment was significantly higher in the intervention group (P = 0.001), and GFR improvement duration was significantly lower in the intervention group (P = 0.002). Conclusions: Montelukast as an add-on drug was effective in reducing the time of GFR enhancement; thus, we can consider it as an add-on drug in azotemia.","PeriodicalId":19466,"journal":{"name":"Nephro-urology Monthly","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48403748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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