Nephro-Urology Monthly
Volume:10 Issue: 2, Mar 2018

Peritonitis is a common serious complication of peritoneal dialysis that results in significant morbidity, mortality, and health care costs. However peritonitis practices vary markedly among different centers and physicians. This article reviews the microbiology, clinical presentations diagnosis, and treatment of peritoneal dialysis related peritonitis focusing on different antibiotic regimens to reduce controversies and tiptoeing through the better approach.

Vascular access (VA) complications are recognized as important causes of hospitalization, morbidity, and mortality in dialysis patients. Thrombosis-induced central catheter failure is the most frequent VA complication. Clopidogrel, as an antiplatelet drug, may increase the patency of central catheters. Nevertheless, there is limited evidence regarding the effects of antiplatelet drugs on central catheter patency.
A total of 100 patients, admitted to our dialysis clinic, were enrolled in this prospective study from January 2014 to June 2016. In this randomized, controlled, comparative study, two groups were recruited and observed to determine the effects of Clopidogrel on the central catheter patency. The function of permanent catheters (permcaths) was evaluated during 6 months. The patients’ demographics, including comorbidities and medical history, were also determined to evaluate the probable effects on permcath patency. In this study, t test was used to analyze quantitative variables, while Chi square and Fisher’s exact tests were used to analyze qualitative variables.
The mean age of patients in the Clopidogrel and placebo groups was 55.5 ± 11.8 and 55.7 ± 12.1 years, respectively. The catheter survival was significantly longer in the Clopidogrel group in comparison with the placebo group (P = 0.02). On the other hand, the frequency of complications showed no significant difference between the groups (P > 0.05).
The results suggest that application of Clopidogrel following permcath insertion may be beneficial for catheter survival.

Infection and its treatment as a common problem in children may induce different complications. Ampicillin and aminoglycosides, as choice drugs for this condition, may have many important side effects, such as nephrotoxic side effects.
Therefore, the aim of this study was to evaluate the nephrotoxic effect of gentamicin and amikacin in neonates with infection.
This clinical trial and double blind study was conducted on 80 children with aminoglycosides addministration. Initially, during hospital admission, serum and urine samples were collected for diagnosis of infection.
Children based on their treatment were divided to 2 groups, 40 children were treated by ampicillin and amikacin and 40 children were treated by ampicillin and gentamicin, during a 7-day period. At the end of the treatment period, serum and urine samples were taken for measurment of laboratory variables, and GFR, for evaluation of kidney function.
Blood Urea Nitrogen (BUN), creatinine and GFR before and after treatment in the two groups did not have statistically significant differences (P > 0.05). In addition age, gender, birth age, infection type, occupation, and education of parents and milk type were equal in the 2 groups.
Based on the present study, there were no significant differences between nephrotoxic effect of gentamicin and amikacin in the two groups.

Cardiovascular disease (CVD) is one of the leading causes of mortality among kidney transplant (KTx) recipients. Left ventricular hypertrophy (LVH) is a known important risk factor for CVD in KTx recipients. The current study aimed at evaluating the association of LVH with hypertension, carotid intima media thickness (CIMT), and serum biomarkers.
The current cross sectional study included KTx recipients; ambulatory blood pressure monitoring, echocardiography, and CIMT measurement were performed. In addition to standard laboratory investigations, high sensitivity C-reactive protein (CRP) and serum homocysteine were measured.
A total of 30 KTx recipients (20 male, 10 female, mean age: 44.53 ± 13.59 years) were enrolled. One-third had diabetes and 73.3% hypertension. Their mean systolic and diastolic blood pressure (BP) was 132.0 ± 14.4 and 77.8 ± 11.3 mmHg, respectively. BP was well controlled, albeit with more antihypertensive agents of 1.5 (interquartile range (IQR): 0 - 4). Their baseline serum creatinine and eGFR were 108.3 (IQR: 66-319) μM/L and 69.8 ± 20.8 mL/min/1.73 m2, respectively. Seven patients had LVH and predominantly had diabetes, a higher pulse pressure, and elevated serum homocysteine. Predictors of left ventricular mass index (LVMI) were the incidence of diabetes, higher pulse pressure, serum homocysteine, and the number of antihypertensive agents prescribed. On multivariate analysis, diabetes and pulse pressure were the main predictors of left ventricular mass index.
LVH is common in patients with KTx, especially in the ones with diabetes. Serum homocysteine is a surrogate marker for LVH.

Achieving target blood pressure is important in retarding the progression of chronic kidney disease (CKD). Optimizing patient's hypertension solely based on clinic blood pressure could be harmful as it may be masked by white coat hypertension.
This study aimed at determining the prevalence of white coat hypertension (WCHT) in patients with CKD and correlating this with their target organ damage evidenced by left ventricular hypertrophy (LVH) and carotid intima media thickness (CIMT).
A cross sectional study of 99 patients with CKD (stage 3 to 5 with eGFR Epi of Ninety-nine patients (42 males and 57 females) with median age of 62 (55 to 69) years old and predominantly Malays ethnicity were recruited. The prevalence of WCHT was 34.3% (34 patients), and 65.7% (65 patients) had sustained hypertension (SHT). Median eGFRs were comparable in both groups (P = 0.479). Despite comparable mean clinic blood pressure (P = 0.85), the WCHT group had significantly lower mean average systolic, daytime, and night time blood pressure when compared with the SHT group (120.82 ± 8.24 vs. 153.20 ± 18.70), (124.50 ± 9.51 vs 155 ± 18.86) , (111.97 ± 20.07 vs 146.22 ± 21.17 ) and diastolic (66.36 ± 85.79 vs. 82.35 ± 12.17), (68.71 ± 10.94 vs 84.11.8) , (62.68 ± 7.78 vs. 79.28 ± 12.17) respectively (P White coat hypertension is prevalent in CKD. Patients with SHT had significant carotid intima thickening; LVH was detected more commonly in the WCHT group.

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that involves many organs, such as the kidneys. Females are most affected and early detection of renal disease activity is very important for morbidity and mortality reduction.
The aim of this study was to determine the relationships between ESR, C3, C4, and anti-dsDNA levels and renal disease activity, based on renal components of the British Isles lupus assessment group (BILAG) index, in females with lupus nephritis (LN).
This study retrospectively reviewed the medical files of 150 females, diagnosed as LN, who were on routine follow-up at Hafez hospital lupus clinic located in Shiraz, Southern part of Iran (during years 2014 to 2015). The BILAG index score was extracted and data was analyzed (α = 0.05).
In all 150 females with SLE, the mean (SD) age was 37.1 (10.6) years. There were significant relationships between BILAG index score and higher ESR level (P value = 0.01), positive anti-dsDNA (P value This study confirmed that the BILAG index score was a valuable predictive index for renal disease involvement in females with LN; thus the authors suggest clinicians to use this index for better LN management.

Hydronephrosis is defined as varying degrees of dilatation in renal pelvis and calyxes, which leads to renal parenchymal atrophy together with obstruction of urinary flow. The present study was conducted to compare levels of urinary cytokine MCP-1 in children with urinary obstruction and healthy children attending Ali-Asghar hospital of the city of Zahedan.
The present case-control study recruited 20 children with obstructive hydronephrosis, 20 children with non-obstructive hydronephrosis, and 30 healthy children as the control group that matched in terms of gender and age and were selected by the convenience sampling method. Urine samples were taken from these children, and urinary creatinine and MCP-1 levels were measured. Data were analyzed with the SPSS-21 software using analysis of variance (ANOVA), Kruskal-Wallis, and Mann-Whitney tests.
Mean MCP-1 level was 542.56 ng/L in the obstructive hydronephrosis group, 424.7 ng/L in the non-obstructive hydronephrosis, and 335.97 ng/L in the control group. Mean MCP-1 to creatinine ratio was 58.94 in the obstructive hydronephrosis group, 39.58 in non-obstructive hydronephrosis, and 33.1 in the control group. Mean MCP-1 and MCP-1 to creatinine ratio was significantly higher in the obstructive hydronephrosis group compared with non-obstructive hydronephrosis and control groups (P The present study results showed that MCP-1 could be a marker for renal tubular injury in patients with obstructive hydronephrosis.

Muscle wasting and protein malnutrition is a common problem in hemodialysis patients and has different complications such as a reduced quality of life, longer hospital stays, and higher mortality rates. The aim of this study was to evaluate the effect of 8 weeks of intradialytic isometric training on muscle capacity and serum albumin levels in hemodialysis (HD) patients.
In a clinical trial, 34 patients were randomly allocated into 2 groups: exercise group (EX) (n = 17) and control group (n = 17). The training program was conducted twice a week for 2 months (24 sessions). Forearm endurance, leg raise endurance, and grip strength were measured for muscle capacity aspect and serum albumin levels, which were evaluated before and post-intervention.
There was no significant difference between the groups in terms of demographic variables (P and gt; 0.05). After the intervention, the muscle capacity variable presented a significant difference between the exercise group and the control group (P and lt; 0.001). As for the albumin levels, there was no significant difference between the 2 groups.
The results showed that exercise during hemodialysis could increase muscle capacity and could be helpful for maintaining the albumin levels in hemodialysis patients.

Hydronephrosis as a major health issue, has a significant contribution to the loss of kidney function and dialysis. Based on this the aim of this was to evaluate the probably etiology of hydronephrosis in neonates.
We have evaluated 314 neonates with fetal hydronephrosis (by ultrasonography) as a study group. Cases were followed by voiding cystourethrogram 3 weeks after the start time. In addition, we took a Diethylenetriaminepentaacetic Acid scan at the end of 1st month of childbirth. At the end, we evaluated data based on the statistical analysis. Based on these examinations, etiology of hydronephrosis were examined and recorded.
In total 314 infants with hydronephrosis (55.7% male and 44.3% female) were included. Idiopathic cause (42%) as the most common etiology and vesicoureteric reflux as 2nd most common etiology of hydronephrosis have been evaluated (37.4%).
Based on this finding, different causes can induce hydronephrosis as a different etiology; therefore, we can control and reduce hydronephrosis by checking vesicoureteric reflux as the most common possible etiology.

Nephrolithiasis occurs in 7% to 40% of patients with primary hyperparathyroidism (PHPT). Approximately 5% of patients with nephrolithiasis will have hyperparathyroidism. This study presents a rare case of hypercalcemia secondary to PHPT, which eventually led to renal failure
This report presents a 55-year-old male presented with history of multiple kidney stones from 6 years ago, who had undergone multiple interventions by extracorporeal shock wave lithotripsy (ESWL). The result of lab exams were: BUN: 48 mg/dL, Cr: 2.83 mg/dL, calcium: 15.8 mg/dL, phosphorus: 4.4, serum intact parathyroid hormone (iPTH) = 1046pg/mL. At T99scan MIBI, the nuclear showed parathyroid adenoma in the inferior pole of the right thyroid. The patient underwent parathyroidectomy. Serum calcium level returned to normal range within 3 days after surgery.
More attention must be paid to patients with recurrent nephrolithiasis, and such patients must be evaluated for PHPT before progressing to CKD.