Journal of nephropathology
Volume:7 Issue: 2, Apr 2018

Hypertension and hyperuricemia are common problems in elderly patients. These problems could be accelerated decrease in glomerular filtration rate (GFR) with aging. It is suggested that lowering uric acid with allopurinol could be beneficial to prevent chronic insufficiency in the elderly patients with hypertension.

Familial Mediterranean Fever (FMF) is the most common inherited autoinflammatory disease. Kidney involvement in FMF is usually attributed to secondary amyloidosis. Non-amyloid glomerular involvement has also been reported.
We suppose that heterozygous mutation of Mediterranean fever (MEFV) gene could be the underlying cause in some cases of mesangial proliferative glomerulonephritis (MePGN) in FMF endemic area.
This prospective study was done between 2013 and 2015 in NorthWest of Iran among the Azari-Turkish population. A panel of MEFV gene including M680I, R761H, M694V, R408Q, E148Q, A744S, F479L, P369S, V726A, M694I, and E167D were studied in a group of patients with idiopathic MePGN. Clinical characteristics and therapeutic responses were compared between those with and without a mutation. A total of 39 idiopathic MePGN patients and 156 healthy subjects were studied.
Heterozygote mutations of MEFV gene were detected in 11/39 (28.2%) of MePGN patients and 46/156 (17.3%) of controls. Clinical response regarding 24 hours urine protein excretion was significant in mutation-negative patients after 6 months of follow-up.
This study shows a possible underlying role of heterozygous MEFV gene mutation in the clinical course of some case of idiopathic MePGN, particularly in FMF endemic population.

Overt proteinuria (OP), an established risk factor for kidney and cardiovascular disease, is much prevalent in high and low body weight individuals.
However, it is equivocal whether trace proteinuria (TrP) is also associated with high and low body weight. Therefore, we address this issue in a large epidemiological study.
Patients and Regarding this association, we examined TrP defined as ± by dipstick urinalysis, in comparison with OP (≥) using the data of 70 886 apparently healthy Japanese men and women who underwent a checkup in 2008, aged 20-85 years old.
The prevalence of TrP, which was slightly but significantly higher (4.1%) on average compared with OP (3.1%), showed a J-shaped relationship against body mass index (BMI). Logistic regression analysis showed that compared to BMI of 21.0-22.9 kg/m2 , other BMI categories except BMI of 19.0–20.9 kg/m2 were significantly associated with TrP, which were not altered after adjustment for relevant confounding factors including age, sex, and pharmacotherapies for hypertension and diabetes. Unlike TrP, OP was not significantly associated with BMI of 23.0–24.9 kg/m2 , a high-normal body weight, although similar trends were observed in the overall relationship between BMI categories and OP.
Current study suggests that TrP is also associated with high and low body weight, seemingly like OP. However, the degree and pattern of associations of TrP with BMI may differ from those of OP. Further study is required particularly in terms of fundamental clinical relevance of TrP.

Unilateral ureteral obstruction (UUO) alters the expression of renin-angiotensin system (RAS) components and angiotensin II (Ang II) as the main arm of RAS is affected by UUO.
In this study the role of Ang II subtypes 1 and 2 receptors (AT1R and AT2R) antagonists (losartan and PD123319) was examined in renal hemodynamic responses to graded Ang II infusion in sham, 3-day UUO and removal UUO (RUUO) models in rats.
Seventy-one male Wistar rats randomly divided into three different sets of animal models; sham-operated, UUO and RUUO that each set contains three groups treated with vehicle, losartan, and PD123319. Renal vascular responses to Ang II infusion were measured at controlled renal perfusion pressure (RPP).
The graded Ang II infusion decreased renal blood flow (RBF), increased renal vascular resistance (RVR) and mean arterial pressure (MAP) in vehicle or PD123319 treated groups significantly (P Vascular responses to Ang II in UUO and RUUO rat model treated with losartan is not as the normal pattern.

Diabetic nephropathy (DN) is one of the major complications of diabetes. Hyperglycemia, inflammation and oxidative stress as well as advanced glycation end products (AGEs) are reported as the risk factors for DN. Sevelamer has shown promising results in reducing inflammation and even HbA1c levels in DN.
We aim to evaluate the therapeutic effects of sevelamer on blood sugar, HbA1c level, lipid profile, and high sensitivity CRP (hs-CRP) in patients with diabetic nephropathy.
Patients and In this clinical trial, 18 patients (13 female with mean age of 61.22±9.32 years) with stages 2-4 of diabetic nephropathy were recruited. Patients were administered with 800 mg of sevelamer twice a day for three months. Blood sugar, HbA1C, hs-CRP, lipid profile and other laboratory findings were measured before and 1, 2 and three months after initiation of the treatment.
There was significant decline in HbA1c (p=0.001), postprandial blood sugar (p=0.02) and phosphorus (p Our results indicated that along with its phosphorus reducing effects, sevelamer plays an important role in decreasing postprandial blood sugar and HbA1c level. Sevelamer had no effects on lipid profile and hs-CRP.

Bladder cancer is a serious global problem. Although the risk factors of bladder cancer have been found through many studies, the effect of them on the grade of this cancer has not been focused previously.
This study was conducted to evaluate the association of some risk factors of urothelial bladder cancer on its grade.
Patients and The patients with proved diagnosis of urothelial carcinoma of bladder were enrolled in this study. They were divided into case group (those with high-grade bladder cancer) and control group (those with low-grade bladder cancer). Each of case and control groups contained 103 patients. Age, gender, place of residence, cigarette smoking state, opium consumption state, occupation, previous exposure to poisons or chemicals, and family history of bladder cancer were compared between the case and control groups.
Eighty-two patients (79.6%) of the case group and 87(84.5%) of the control group were male. The mean age of the case group was significantly higher than control group (66.1±11.8 and 61.7±14.2, respectively; P=0.003). The results of this study showed that ever usage of opium was significantly higher in the case group (OR=2.97; 95% CI: 1.64- 5.38; P High grade urothelial bladder cancer has been significantly associated with opium usage and older ages

Thrombotic thrombocytopenic purpura (TTP) is a common form of thrombotic microangiopathy. These patients have renal insufficiency as well as thrombocytopenia and microangiopathic hemolysis.
The present study was aimed to assess if TTP patients with renal failure have prompting polymorphisms in the complement system genes as seen in patients with the atypical hemolytic uremic syndrome (aHUS).
Patients and Twenty TTP patients and 30 healthy individuals were included. Two single-nucleotide polymorphisms rs3753394 and rs2230199 respectively in the complement factor H (CFH) and complement component 3 (C3) genes were determined using the PCRrestriction fragment length polymorphism (RFLP) method. To evaluate the power of the associations between the polymorphisms and TTP development, odds ratios (ORs) and 95% confidence intervals (CIs) were employed.
In rs2230199 polymorphism, the frequency of the C and G alleles and genotype were not significantly different in case and control groups. Moreover, the frequency of T allele and CC, CT, and TT genotypes of the rs3753394 polymorphism in TTP patients were not significantly different from those in the controls, the OR of 0.77 [CI: 0.33 to 1.79] and 0.76 [CI: 0.24 to 2.38], respectively (P > 0.05).
Based on our results, there was no significant association between the incidence of TTP and polymorphisms of the CFH and C3 genes, neither at the allele nor at the genotypic levels (P > 0.05). This finding can be affected by the limited sample size or the genetic context of the studied population.

Renin-angiotensin system (RAS) plays an important role in cardiovascular and kidney functions to regulate the systematic blood pressure. The baroreflex sensitivity (BRS) index is a quantitative index that was considered as a prognostic indicator for cardiovascular system risk which is known as heart rate change to blood pressure change ratio ( HR MAP ∆ ∆ ). Sympathetic nerve is an arm of the BRS which may be influenced by RAS vasodilatory arm function.
To determine the role of angiotensin 1-7 (Ang1-7) accompanied by bilateral renal denervation (RDN) on BRS and renal function.
Male and female anesthetized Wistar rats were subjected to RDN and treated with Ang1-7 (300 and 1000 ng.kg-1.min-1). Mean arterial pressure (MAP) and heart rate (HR) responses to phenylephrine (PE) infusion were measured to determine BRS index. As kidney function markers, the creatinine clearance (CrCl) and urine flow (UF) were also determined.
The results showed that BRS increased significantly in RDN male rats treated with Ang1-7 compared to vehicle (P The Ang1-7 infusion could alter the BRS index in RDN rat’s gender dependently. The ClCr response to Ang1-7 infusion in male rats was dose related.

In the recent years, the prevalence of metal-induced toxicity, especially leadinduced toxicity, has increased considerably. Metals including lead cause oxidative stress. Therefore Rheum ribes L. as a medicinal plant with antioxidant activity may reduce the complications of these toxicities.
The aim of the current study was to investigate the protective effect of hydroalcoholic R. ribes L. extract in male rat model of lead acetate-induced nephrotoxicity.
In this experimental study, 40 male Wistar rats were randomly assigned to four groups: Normal saline (control) group, positive control group treated with 0.6 g/L/d of lead acetate in drinking water, and two R. ribes groups treated with 200 and 400 mg/kg/d of R. ribes extract in addition to lead acetate for 10 days. After treatment, the rats were anesthetized, blood samples were taken, and kidneys were removed and fixed in 10% formalin. Then, serum antioxidant capacity was measured and kidney tissue specimens histopathologically studied.
Serum antioxidant capacity was significantly different between lead acetate group and the group treated with lead acetate R. ribes extract (400 mg/kg). Additionally mice receiving lead acetate R. ribes extract (400 mg/kg) had significantly higher antioxidant capacity than the control group (P Rheum ribes extract can prevent lead-induced kidney damage, and therefore exposure to lead acetate by people are recommended to consume this extract.

Context: One of the main events associated with ischemia/reperfusion injury (IRI) is excessive production of reactive oxygen species (ROS). Zinc (Zn) and estradiol are considered as antioxidants that scavenge free radicals.
The aim of this study was to compare the protective effect of Zn and estradiol against renal IRI in ovariectomized rats.
Ovariectomized Wistar rats were randomly divided into five experimental groups including control (sham operated), IRI, estradiol treated ℒ, estradiol and Zn treated ℒ, Zn treated ℒ groups. The IRI was induced by clamping renal vessels for 45 minutes followed by 24 hours reperfusion. During the last 6 hours of reperfusion, urine output was collected and the measurements were performed.
IRI caused an increase in kidney tissue damage score (KTDS) significantly (P Zn protected the kidney against IRI with an evident improvements of serum BUN and Cr levels, Cr clearance and tissue damage.

Phospholipase A2 receptor (PLA2R) is thought to be an intrinsic antigen of idiopathic membranous nephropathy (IMN), and has been widely used for the differentiation from secondary membranous nephropathies. However, the positive expression of PLA2R in the patients with hepatitis B virus associated membranous nephropathy (HBV-MN) is controversial in Asian countries, because co-localization of PLA2R and HBV antigens in glomeruli have been reported.
We report a case of anti PLA2R antibody positive HBV-MN that was remitted with entecavir after a relapse during treatment with lamivudine. In a renal biopsy of the case, we could confirm the co-localized glomerular deposition of HBV surface antigen (HBs-Ag) and PLA2R using double staining of immunofluorescence. We also could observe the relapse of nephrotic syndrome correlated with the increased titer of HBs-Ag, and the remission with the decrease of HBs-Ag by the change of antiviral agents.
Our case demonstrated that the renal manifestation of HBV-MN clearly responded to antiviral agents. Furthermore, the co-localized glomerular depositions of PLA2R and HBs-Ag in HBV-MN may be concerned with the etiology of MN patients with chronic HBV infection.

A horseshoe kidney is the most common renal fusion anomaly and occurs in 0.2% to 0.3% of the population. Horseshoe kidneys are fused by the formation of an isthmus between the lower poles of the left and right kidneys during development. The insertion of the ureter in the renal pelvis is displaced super-laterally, probably as the result of incomplete renal rotation, and is associated with a significant rate of ureteropelvic junction (UPJ) obstruction.
We report a patient with single kidney at right side with obstruction in upper ureter. Before the surgery our plan was transureteroureterostomy according to failure of previous surgeries, dismembered pyeloplasty and ureterocalicostomy, but after mobilizing the proximal ureter we noticed that transureteroureterostomy was impossible because of short fibrotic ureter. Other choices such as Boari flap technique with psoas hitch is impossible because of small fibrotic bladder, so we decided to use appendix as ureter substitute.
According to our experience and previous studies, we can use appendix as a ureter substitution in refractory proximal and middle ureter stenosis, but in our case we anatomized proximal ureter to appendix instead of anastomosis of pelvic to appendix.