فهرست مطالب

Kidney Diseases - Volume:11 Issue: 4, Jul 2017

Iranian Journal of Kidney Diseases
Volume:11 Issue: 4, Jul 2017

  • تاریخ انتشار: 1396/06/07
  • تعداد عناوین: 11
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  • Afagh Hassanzadeh Rad, Hamidreza Badeli Pages 259-262
    In the past 3 decades, ultrasonography has gifted internal organs visualization to physicians to have a better detection of various diseases. Previously performed solely by radiologists as a method with high feasibility and accuracy, recently ultrasonography is being recommended and used by many other physicians in practice. Ultrasonography not only can be used to diagnose and manage kidney diseases, but also is an essential tool in nephrology for the guidance of invasive procedures. This method of bedside ultrasonography by physicians in real time is called point-of-care ultrasonography (POCUS). Given the limitations of collecting information by routine physical examination in kidney diseases and the simplicity of performing ultrasonography to examine kidney location, architecture, and restricted pathologies, nephrologists that have been lagging in this area, should join the spectrum of clinicians using the POCUS to provide safe and rapid diagnosis of common renal abnormalities. Although physicians may imagine POCUS as a difficult tool to use and there has been an initial resistance and reluctance to use ultrasonography by nonradiologists, investigations have shown that learning and doing POCUS was possible even for undergraduate medical students during a short course. According to the collected evidence in the field of POCUS in different branches of medicine, it seems that it should be added to nephrology examination room in the near future.
    Keywords: ultrasonography, nephrology, kidneys, point-ofcare systems
  • Intisar Hamed Al Alawi, Issa Al Salmi, Adhra Al Mawali, John A. Sayer Pages 263-270
    Oman is located in the southeast of Arabian Peninsula with a relatively young population of about 3 831 553 people. The Ministry of Health, which is the healthcare provider, is facing a challenge with the increased levels of noncommunicable diseases including chronic kidney disease. A growing number of patients progress to end-stage kidney disease (ESKD), demanding renal replacement therapy. In 2014, there were 1339 of ESKD patients receiving dialysis and almost 1400 patients received kidney transplants. The estimated annual incidence of ESKD is 120 patients per million population. Diabetes mellitus and hypertensive nephropathy are the commonly identified causes of ESKD. Many patients with glomerulonephritis, systemic lupus erythematosus, nephrolithiasis, and inherited kidney disease present with advanced chronic kidney disease. This article reviews the current status of kidney disease in Oman and addresses the present and future needs, through a systematic-review of all related papers.
    Keywords: Ministry of Health, noncommunicable diseases, chronic kidney disease, endstage kidney disease
  • Asima Tayyeb, Naveed Shahzad, Gibran Ali Pages 271-279
    Introduction
    Mesenchymal stem cells (MSCs) have been publicized to ameliorate kidney injury both in vitro and in vivo. However, very less is known if MSCs can be differentiated towards renal lineages and their further application potential in kidney injuries.
    Materials And Methods
    The present study developed a conditioning system of growth factors fibroblast growth factor 2, transforming growth factor-β2, and leukemia inhibitory factor for in vitro differentiation of MSCs isolated from different sources towards nephrogenic lineage. Less invasively isolated adipose-derived MSCs were also compared to bone marrow-derived MSCs for their differentiation potential to induce renal cell. Differentiated MSCs were further evaluated for their resistance to oxidative stress induced by oxygen peroxide.
    Results
    A combination of growth factors successfully induced differentiation of MSCs. Both types of differentiated cells showed significant expression of pronephrogenic markers (Wnt4, Wt1, and Pax2) and renal epithelial markers (Ecad and ZO1). In contrast, expression of mesenchymal stem cells marker Oct4 and Vim were downregulated. Furthermore, differentiated adipose-derived MSCs and bone marrow-derived MSCs showed enhanced and comparable resistance to oxygen peroxide-induced oxidative stress.
    Conclusions
    Adipose-derived MSC provides a promising alternative to bone marrow-derived MSC as a source of autologous stem cells in human kidney injuries. In addition, differentiated MSCs with further in vivo investigations may serve as a cell source for tissue engineering or cell therapy in different renal ailments.
    Keywords: adipose tissue, differentiation, stem cell, senescence
  • Hamid Barahimi, Mitra Zolfaghari, Farid Abolhassani, Abass Rahimi Foroushani, Aeen Mohammadi, Farahnaz Rajaee Pages 280-285
    Introduction
    Chronic kidney disease (CKD) is a challenging health problem. The present study examined impact of self-care education through e-learning on improving kidney function among individuals with CKD.
    Materials And Methods
    The studied population consisted of CKD patients receiving care at 10 centers for treating noncommunicable diseases in Tehran. Three centers were randomly selected and 39 patients with a glomerular filtration rate (GFR) less than 60 mL/ min/1.73 m2, minimum education of grade 9, minimum of 2 years of referrals, and computer literacy of the individual or a firstdegree relative were included in the study, while 92 patients were assigned into the control group. Changes in GFR were compared after 6 months following an e-learning program for the patients in the intervention group.
    Results
    The mean change in GFR was 7.5 ± 8.9 mL/min/1.73 m2 for the intervention group after the e-learning intervention, while this was -2.3 ± 8.5 mL/min/1.73 m2. The two groups were also significantly different in terms of age, marital status, education level, mean arterial pressure, and serum high-density lipoprotein level, and therefore, multivariable comparison of GFR was made incorporating these factor into the analysis and showed a significant improvement of GFR in the intervention group.
    Conclusions
    According to the results of this study, effects of the e-learning educational intervention on improvement in kidney function and CKD treatment were established.
    Keywords: e-learning, chronic kidney disease, intervention
  • Sima Golmohammadi, Afshin Almasi, M. Manouchehri, Hamid Reza Omrani, Mohammad Reza Zandkarimi Pages 286-293
    Introduction
    Hyperuricemia is common in approximately 50% of patients with kidney failure due to decreased uric acid excretion, and it has been recently known as an independent factor in the progression of renal insufficiency. Allopurinol inhibits the production of uric acid. The aim of this study was to evaluate the effect of allopurinol on chronic kidney disease progression.
    Materials And Methods
    In a clinical trial, patients with stages 3 and 4 of chronic kidney disease were divided into two groups to receive allopurinol, 100 mg, daily and placebo for 12 months. Patients’ kidney function and serum uric acid levels were assessed at baseline and 3, 6, and 12 months after initial administration. Subgroups of patients with severe and mild glomerular filtration rate (GFR) impairment (GFR, 15 mL/min/1.73 m2 to 30 mL/min/1.73 m2 and 30 mL/min/1.73 m2 to 60 mL/min/1.73 m2, respectively), were compared between the groups.
    Results
    Serum uric acid levels decreased significantly during after 12 months of allopurinol administration (P = .004). In patients with severe GFR impairment, serum creatinine levels did not decrease significantly and there was no significant increase in GFR, but in those with mild GFR impairment, serum creatinine levels decreased and GFR increase significantly (P
    Conclusions
    Allopurinol may slow down stage 3 chronic kidney disease progression and could be administered with other effective medications for controlling the kidney disease.
    Keywords: allopurinol, glomerular filtration rate, hyperuricemia, chronic kidney disease
  • Hamid Tayebi Khosroshahi, Behzad Abedi, Sabalan Daneshvar, Effat Alizadeh, Mohammadreza Khalilzadeh, Yaghoub Abedi Pages 294-302
    Introduction
    One of the most important issues in patients with chronic kidney disease is fluid retention and volume overload accompanied by retention of nitrogenous waste products and some electrolytes. Bowel fluid contains high levels of urea, creatinine, uric acid, and electrolytes, which make it a potential candidate for intestinal excretion of nitrogen wastes and electrolytes. Cross-linked polyelectrolyte (CLP) is a polymer that, given orally, absorbs excess fluid, electrolyte, and nitrogenous waste products.
    Materials And Methods
    In an experimental study on 30 hemodialysis patients, the effect of CLP on adsorption of fluid, urea, creatinine, uric acid, sodium, and potassium were evaluated. For this purpose, 500 mL of effluent fluid of each patient were collected at the 1st hour of dialysis. The concentrations of the abovementioned products were measured by standard methods. Then the dialysate effluent samples were treated with 6 g of CLP and incubated for 4 hours at 37°C.
    Results
    Up to 80% of effluent fluid water was adsorbed by CLP. There were significant reductions in urea, creatinine, uric acid, and sodium levels in the remaining effluent fluid (P
    Conclusions
    Using CLP in addition to functional medical super adsorbents can be a possible adequate substitute for conventional dialysis methods, especially hemodialysis.
    Keywords: Cross-linked polyelectrolyte, dialysis, chronic kidney disease, nitrogenous waste products, volume overload
  • Hugo Hyung Bok Yoo, Roberto Dos Reis, Wagner Moneda Telini, Lidiane Rodrigues Telini, Joao Carlos Hueb, Silmeia Garcia Zanati Bazan, Pasqual Barretti, Luis Cuadrado Martin, Thais Thomaz Queluz Pages 303-308
    Introduction
    Pulmonary hypertension (PH) has been reported in hemodialysis patients, but data regarding its pathogenesis are scarce. This study aimed to evaluate the role of fluid overload in PH and its interrelationships with the usual biomarkers of microinflammatory state in hemodialysis patients.
    Materials And Methods
    In is a cross-sectional and prospective study, 119 consecutive hemodialysis patients at a Brazilian referral university hospital were evaluated between March 2007 and February 2013. Based on the presence of echocardiographic parameters of PH, patients were allocated to two groups of the PH group and the non-PH group. Clinical parameters, site and type of vascular access, bio-impedance, and laboratory findings were compared between the two groups and a logistic regression model was elaborated.
    Results
    Pulmonary hypertension was found in 23 (19.0%) of 119 patients. The groups significantly differed in extracellular water, ventricular thickness, left atrium diameter, and ventricular filling. Additionally, laboratory data associated with PH were alpha- 1-acid glycoprotein (140.0 ± 32.9 versus 116.0 ± 35.5; P
    Conclusions
    Pulmonary hypertension, cardiac hypertrophy, fluid overload, and inflammation were associated to each other in hemodialysis patients, providing insight into its pathogenesis. Longitudinal studies are warranted.
    Keywords: alpha-1-acid glycoprotein, B-type natriuretic peptide, end-stage renal disease, fluid overload, hemodialysis, inflammation, pulmonary hypertension
  • Sepideh Zununi Vahed, Ahmad Poursadegh Zonouzi, Hossein Ghanbarian, Moteza Ghojazadeh, Nasser Samadi, Mohammadreza Ardalan Pages 309-318
    Introduction
    The discovery of circulating microRNAs (miRNAs), as potential noninvasive diagnostic biomarkers, has opened new avenues of research for identifying transplant patients with chronic allograft dysfunction. The present study aimed to investigate the expression levels of 4 immune-related miRNAs, miR-21, miR-31, miR-142-3p, and miR-155, in plasma samples of kidney allograft recipients.
    Materials And Methods
    The plasma expression levels of the miRNAs were evaluated by quantitative real-time polymerase chain reaction in 53 kidney recipients with long-term stable allograft function (n = 27), biopsy-proven interstitial fibrosis and tubular atrophy (n = 26), and healthy controls (n = 15). The possible correlation between clinical parameters and the circulating miRNAs and the receiver-operating characteristic analysis were performed.
    Results
    Significantly upregulated expressions of miR-21 (P = .02), miR-142-3p (P = .048), and miR-155 (P = .005) were observed in plasma samples of recipients with interstitial fibrosis and tubular atrophy in comparison to the stable allograft function and healthy control groups. Expression level of the miR-21 in plasma was correlated with creatinine (r = -0.432, P = .03) and estimated glomerular filtration rate (r = 0.423, P = .031). Multivariable analysis indicated that miR-21, miR-142-3p, and miR-155 in plasma samples could discriminate almost most of the patients with interstitial fibrosis and tubular atrophy (area under curve, 0.802; sensitivity, 81%; specificity, 92%).
    Conclusions
    Our data suggested that altered expression of miR-21, miR-142-3p, and miR-155 in plasma samples might be associated with kidney allograft dysfunction and could be used for graft monitoring in kidney transplantation.
    Keywords: kidney transplantation, circulating microRNAs, interstitial fibrosis, tubular atrophy
  • Nuran Cetin, Nadide Melike Sav, Evrim Ciftci, Bilal Yildiz Pages 319-321
    Foreign body reaction is a tissue response against implanted materials. We described for the first time the eosinophilic peritonitis and foreign body giant cell reaction to dialysis catheter in anonatopic child on continuous ambulatory peritoneal dialysis. We found tenderness, redness, and swelling without purulent discharge around the peritoneal catheter; increased eosinophil count in cloudy dialysis fluid; and blood and hyperechoic granulomatous formation appearance surrounding the peritoneal catheter onultrasonography and foreign body giant cell reaction to dialysis catheter in pathologic examination of granulomatous lesionin in our patient. The peritoneal dialysis catheter was removed due to resistance to antibiotic and antihistamine treatments for suspected peritonitis and tunnel infection. Foreign body reaction and eosinophilic peritonitis with eosinophilic cloudy dialysis effluent can exist simultaneously. Foreign body reaction should be considered in the differential diagnosis of exit site and/or tunnel infection. Ultrasonography helps distinguish between foreign body reaction and exit-site or tunnel infection.
    Keywords: foreign body reaction, peritoneal effluent eosinophilia, eosinophilic peritonitis, peritoneal dialysis, child
  • Min-Kyung Yeo, Young Rok Ham, Song-Yi Choi, Yong-Moon Lee, Moon Hyang Park, Kwang-Sun Suh Pages 322-325
    Kidney transplantation for amyloidosis remains a contentious issue. Recurrence of amyloidosis is one of the risks of transplantation. Chronic active antibody-mediated rejection is an important cause of chronic allograft dysfunction. A 47-year-old woman underwent kidney transplantation due to renal AA amyloidosis with unknown etiology. Six years posttransplantation, a kidney biopsy showed AA amyloidosis with chronic active antibody-mediated rejection. Donor-specific antibody class II was positive. The patient underwent intravenous plasmapheresis and treatment with rituximab and colchicine. The relationship between recurrence of amyloidosis and rejection was not obvious. Clinical characteristics of kidney transplantation for AA amyloidosis were subjected to literature review and 315 cases were identified. The incidence of amyloidosis recurrence and acute and chronic rejection rates were 15%, 15%, and 8%, respectively. Five-year patient and graft survival rates were 77% and 82%, respectively. Clinical courses of kidney transplantation in AA amyloidosis were, thus, identified.
    Keywords: Amyloidosis, kidney transplantation, recurrence, allograft rejection