جستجوی مقالات مرتبط با کلیدواژه « renal insufficiency » در نشریات گروه « پزشکی »

Chronic Kidney Disease (CKD) patients often face complex health challenges, including cardiovascular and pulmonary issues. Smoking is a recognized risk factor for these conditions, but its specific impact on CKD patients remains less understood.

In this cross-sectional study, we investigated the relationship between smoking habits and cardiopulmonary health among CKD patients. We examined baseline characteristics, including demographics, medical history, and biochemical markers, in a cohort of CKD patients. Cardiopulmonary parameters were assessed during exercise testing, including oxygen consumption, ventilation rates, ventilation-perfusion matching markers, and oxygen saturation levels.

Our findings revealed no statistically significant differences in cardiopulmonary parameters between smokers and non-smokers within the CKD patient population. This suggests that the relationship between smoking and exercise capacity in CKD patients is complex and influenced by multiple factors. Our analysis of demographics, comorbidities, and medication history provided critical context for interpreting these results.

This study contributes to our understanding of the intricate relationship between smoking habits and cardiopulmonary health in CKD patients. While smoking is recognized as a risk factor, its specific impact on exercise capacity within this population may be influenced by individual variables. Further research is needed to explore these relationships in larger and more diverse cohorts. These findings underscore the importance of considering multiple variables when assessing the impact of smoking on the health of CKD patients.

 Cerebral small vessel disease (CSVD) is a chronic disorder affecting small vessels within the brain, increasing the risk of stroke in patients with chronic kidney disease (CKD). Diffusion tensor imaging (DTI) is a newer quantitative method for diagnosing CSVD at an early stage of pathogenesis.

 This study compares various DTI parameters in multiple white matter tracts of the brain in CKD patients undergoing maintenance hemodialysis with normal controls in the Indian population using the volume of interest (VOI) method. Additionally, it correlates these DTI parameters with each other at different locations to gain insights into the pathogenesis of CSVD.

 After obtaining institutional ethics approval, a cross-sectional study was conducted at a tertiary care hospital over one year (June 2022 to May 2023). The study comprised seventy-five patients in the hemodialysis group and twenty-five controls. All participants underwent MRI brain examinations on a 3 Tesla MRI scanner, and the four DTI parameters - fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD) - were reviewed for nine white matter tracts to evaluate statistical differences and correlations.

 Fractional anisotropy was significantly decreased at anterior locations – corpus callosum genu (P = 0. 357 × 10-7), right anterior corona radiata (P = 0.001), and left anterior corona radiata (P = 0.45 × 10-5). In these locations, FA negatively correlated with RD (R = -0.7904, P < 0.00001), and RD was also significantly increased. Axial diffusivity was significantly increased at posterior locations in the corpus callosum splenium (P = 0.108 × 10-5) and left posterior corona radiata (P = 0.244 × 10-5). However, none of the four DTI parameters showed significant differences between hemodialysis patients and the control group for the subset of patients with normal routine brain MRI features. The intraclass correlation coefficients (ICCs) were high for all four DTI parameters for both patients (0.78 to 0.85) and controls (0.82 to 0.89).

 This study on CKD patients undergoing maintenance hemodialysis reveals significant differences in some DTI parameters in widespread white matter tracts of the brain using the VOI method, with acceptable to excellent interobserver agreement.

Hyperphosphatemia is an independent risk factor for mortality in chronic kidney disease (CKD) patients.

This systematic review and meta-analysis aimed to investigate the effect of Sevelamer on serum phosphorus levels in CKD and hemodialysis patients.

The data were obtained after searching the international databases of Cochrane, PubMed, Scopus, Web of Science, and the Google Scholar search engine until February 28, 2023. The heterogeneity of articles was assessed using the I2 index. The data were analyzed in STATA 14, and P values < 0.05 were considered significant.

A total of 22 articles were assessed with a total sample size of 3221. Sevelamer reduced calcium levels in CKD and hemodialysis patients compared with those in the comparison group (standardized mean difference [SMD]: -0.67; 95% CI: -1.23, -0.11); however, sevelamer had no significant effect on serum parathyroid hormone (PTH) levels (SMD: 0.07; 95% CI: -0.39, 0.54) and Ca × P product (SMD: -0.20; 95% CI: -0.41, 0). A significant decrease in serum phosphorus level was observed in patients who had taken sevelamer for a maximum of 12 weeks compared with the comparison group (SMD: -0.27; 95% CI: -0.54, -0.01); however, no significant decrease in serum phosphorus level was observed in patients who had taken sevelamer for more than 12 weeks. A significant decrease in serum phosphorus level was observed in sevelamer users compared to placebo group members (SMD: -0.36; 95% CI: -0.68, -0.05).

The administration of sevelamer reduced serum phosphorus levels in CKD and hemodialysis patients compared with those in the placebo group in the short term. Therefore, physicians are recommended to prescribe sevelamer for a maximum period of three months. Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO website (ID: CRD42023406804).

Membranous nephropathy (MN) has variable clinical outcomes, ranging from spontaneous remission to slow progression to kidney failure. Since the clinical outcomes of MN have not been studied in a large sample size in Iran, this study was designed to evaluate the outcome of patients diagnosed with MN at Hasheminejad Kidney Center (HKC), Tehran.

In this retrospective cohort study, 1086 patients with a diagnosis of MN who were biopsied between 1998 and 2018 in HKC were evaluated through a review of medical records for baseline clinical and laboratory characteristics at the time of biopsy and through a review of follow-up charts and phone calls for the evaluation of clinical outcomes. Of these patients, 551 could be followed for clinical outcomes. The composite outcome included kidney loss (hemodialysis, transplantation, or death). The effect of demographic, clinical, laboratory, and pathological variables on kidney survival was determined by the Cox-regression model using SPSS-16 software at a significance level of .05.

Results: 

Sex (P < .05), higher weight (P < .05), older age (P < .001), hypertension (P < .001), higher baseline proteinuria and lower glomerular filtration rate (GFR) at the onset of the disease were associated with kidney failure (P < .001). A higher percentage of interstitial fibrosis, tubular atrophy, global sclerosis, and a higher pathological class of membranous nephropathy were significantly associated with disease outcome in the univariate Cox-regression analysis (P < .001). Kidney survival rates at 5, 10, and 15 years were 86%, 74%, and 56%; respectively.

Our study suggests that baseline demographic, clinical and laboratory factors affect kidney outcomes. Patients who are considered high-risk based on the criteria listed above may need to be candidates for more aggressive therapy.

Magnesium oxide may be effective in renal insufficiency prevention after carboplatin therapy. We have evaluated magnesium oxide impression on the serum creatinine (Cr) and blood urea nitrogen (BUN) levels plus glomerular filtration rate (GFR) in cancerous children.

A group of children with different cancers (n = 18) was treated with 250 mg/day magnesium oxide supplementation (MOS) and compared with a matched placebo‑treated group (n = 18). After 2 weeks, carboplatin chemotherapy started. We compared serum Cr, BUN, and GFR values before and 3 and 7 days post intervention.

Serum Cr and BUN were increased significantly 3 and 7 days after intervention in both the groups. Serum Cr and BUN were not statistically different between the MOS and placebo groups before the intervention and 3 or 7 days after carboplatin administration (P > 0.05). Three days after the intervention, the GFR reduced from 101.38 ± 14.67 to 90.11 ± 10.52 mL/min/1.73 m2 in the MOS group. Furthermore, in the placebo group, 3 days after the intervention, the GFR was reduced from 97.5 ± 9.71 to 92.33 ± 10.61 mL/min/1.73 m2 . Further, in the MOS group, after 7 days of the intervention, the GFR was reduced to 84.11 ± 12.47 mL/min/1.73 m2 . In the placebo group, after 7 days of the intervention, the GFR was diminished to 85.38 ± 10.66 mL/min/1.73 m² (P = 0.371).

The current study suggests that magnesium supplementation does not prevent carboplatin‑induced nephrotoxicity in children with malignancies. Anyway, we propose magnesium oxide supplementation for this group of pediatrics because magnesium is an essential element for cell and tissue growth, maintenance, and metabolism.

Kidney disorders are mainly diagnosed after a major decline in the renal function. Chronic kidney disease (CKD) is one of the most common disorders of the urinary system defined by gradual reduction of renal function. Considering the silent nature and late diagnosis of this problem, this study aims to investigate the prevalence of CKD and its association with Complete Blood Count (CBC) profile and liver function tests.

Out of the total population enrolled in the Tabari cohort study, 5822 subjects without history of diabetes mellitus, hypertension, cardiac disease, renal failure, cancer, and pathologic obesity were selected. Glomerular filtration rate (GFR) was calculated using creatinine clearance as well as Modification of Diet in Renal Disease (MDRD) equation. CKD was defined as GFR decline less than 60 ml/min/1.73 m2 regardless of its main cause.

Prevalence of CKD in total population as well as men and women was 20.2%, 16.8%, and 23.1%, respectively. Multivariate models showed the odds ratios for third and fourth quartiles of Mean corpuscular volume (MCV) and also for the fourth quartile of the lymphocyte count as of 0.78 (0.64, 0.95), 0.81 (0.67, 0.99), and 1.22 (1.01, 1.47), respectively. Corresponding odds ratios for the fourth, third, and second quartiles of Blood Urea Nitrogen (BUN) were 1.42 (1.14, 1.77), 1.76 (1.42, 2.19), and 2.79 (2.27, 3.43), respectively.

This study showed a high prevalence of CKD among the normal residents (without major underlying diseases and excessive obesity) in the north of Iran, especially among women. In addition, low MCV, low lymphocyte, and high BUN were detected as predictors of this disorder.

Little is known about the relationship between renal insufficiency and time after cancer diagnosis.

The data of 71,302 individuals (aged 19 to 79 yr) that participated in the 2007–2019 Korean National Health and Nutrition Examination Surveys were subjected to analysis. Renal insufficiency was defined as an estimated glomerular filtration rate of < 60 ml/min/1.73 m2. Odds ratios of renal insufficiency were estimated using multivariate logistic regression models adjusted for potential covariates.

Of the 71,302 study subjects, 3.7% were cancer survivors and 2.2% were long-term (≥ 5 yr) survivors. Renal insufficiency was significantly more prevalent among short-term survivors, but not among long-term survivors, than among subjects without cancer.

A cancer history of ≥ 5 yr is not an independent risk factor of renal insufficiency.

Chronic kidney disease (CKD) is a systemic disease with a major burden on several life aspects, including oral health. As life expectancy has improved in CKD patients, oral health status has become important regarding their quality of life. The aim of this study was to investigate oral health and oral health‑related quality of life (OHRQoL) in CKD patients.

This was a cross‑sectional study. Patients’ age, gender, and estimated glomerular filtration rate (eGFR) stage were recorded. Oral Health Impact Profile‑14 (OHIP‑14) was used to evaluate OHRQoL. Decayed, missing, and filled teeth (DMFT) index was utilized to record oral health status. SPSS software was used to analyze data. One-way ANOVA, t-test and Pearson/Spearman correlations were used. P < 0.05 was considered statistically significant.

One hundred and four patients participated; 60.6% male versus 39.4% female. Mean age was 52.1 ± 18.1 years. The most frequent eGFR stage was 5 (41.2%). Mean DMFT score was 18.7 ± 8.5. Mean OHIP‑14 score was 14.82 ± 5.86. DMFT score was significantly correlated with OHIP‑14 total score as well as its physical domains (P < 0.05). The correlation between eGFR stage and OHIP‑14/DMFT score was both statistically significant (P = 0.03/P = 0.02, respectively).

DMFT score was significantly correlated with OHRQoL in CKD patients, especially regarding its physical domains. Paying attention to fulfill dental treatment needs seems mandatory to improve OHRQoL and overall quality of life in these patients.

Renal insufficiency is one of the inevitable complications in patients with Wilms tumor (WT). The purpose of this study was to assess the renal function in children with WT at baseline and every 3 months to 2 years.

In a descriptive‑analytical study from 2018 to 2020, 48 children with WT were included in the study. Urine creatinine (UCr), serum calcium (SCr), blood pressure (BP), estimated glomerular filtration rate (eGFR), and urinary protein (UPro) were evaluated at baseline and every 3 months during the study. Spot UCa/UCr and spot UPro/UCr ratio were calculated. Kidney ultrasonography was used in all patients. Independent Sample t‑test and Chi‑square tests were utilized to compare age and sex, respectively.

The mean age of patients at follow‑up was 7.3 years. There was no significant difference in mean UCr, SCr, eGFR, 24‑h UPro, UCa/UCr ratio, and spot UPro/UCr ratio at baseline and end of study (Pbaseline > 0.05, Pend of study > 0.05). Analysis of kidney size showed a statistical association with tumor stage (P < 0.05). Comparison of the kidney size in patients showed that there is a statistically significant difference (P < 0.0001) at baseline and end of the study.

This study showed that as WT progressed, the size of the kidneys increases without any renal insufficiency. Therefore, it seems that urinalysis of patients with WT along with sonography is necessary to determine renal insufficiency and the use of ultrasound alone to determine kidney insufficiency is not recommended.

Chronic kidney disease (CKD) is a systemic disease with a major burden on several life aspects, including oral health. As life expectancy has improved in CKD patients, oral health status has become important regarding their quality of life. The aim of this study was to investigate oral health and oral health‑related quality of life (OHRQoL) in CKD patients.

This was a cross‑sectional study. Patients’ age, gender, and estimated glomerular filtration rate (eGFR) stage were recorded. Oral Health Impact Profile‑14 (OHIP‑14) was used to evaluate OHRQoL. Decayed, missing, and filled teeth (DMFT) index was utilized to record oral health status. SPSS software was used to analyze data. One-way ANOVA, t-test and Pearson/Spearman correlations were used. P < 0.05 was considered statistically significant.

One hundred and four patients participated; 60.6% male versus 39.4% female. Mean age was 52.1 ± 18.1 years. The most frequent eGFR stage was 5 (41.2%). Mean DMFT score was 18.7 ± 8.5. Mean OHIP‑14 score was 14.82 ± 5.86. DMFT score was significantly correlated with OHIP‑14 total score as well as its physical domains (P < 0.05). The correlation between eGFR stage and OHIP‑14/DMFT score was both statistically significant (P = 0.03/P = 0.02, respectively).

DMFT score was significantly correlated with OHRQoL in CKD patients, especially regarding its physical domains. Paying attention to fulfill dental treatment needs seems mandatory to improve OHRQoL and overall quality of life in these patients

Lupus nephritis (LN) is one of the most serious complications of systemic lupus erythematosus (SLE).The neutrophil to lymphocyte ratio (NLR) is a promising predictor and prognostic factor. An increased NLR is associated with a poor prognosis of several inflammatory diseases. To evaluate the value of NLR in the diagnosis and pre-assessment of the disease severity of LN. This retrospective study included 88 patients with LN, 51 SLE patients without kidney involvement, 79 patients with primary chronic nephritis (CN), and 52 healthy controls (HC). The differences among these four groups and diagnostic value of NLR for patients with LN were evaluated. The NLR of patients with LN before treatment was significantly higher than that of the other three groups. NLR positively correlated with C-reactive protein (CRP), complement 3(C3), C4, and serum creatinine (SCr) (CRP: r=0.337, p=0.007; C3: r=0.222, p=0.042; C4: r=0.230, p=0.035; SCr: r=0.408, p <0.0001) but negatively correlated with total serum IgG (r=-0.226, p=0.041). The level of NLR increased with the severity of renal dysfunction NLR (area under the curve: 0.785, 95% CI: 0.708-0.862) was useful for the diagnosis of LN, and its optimal cut-off value was 5.44 (sensitivity: 65.9%, specificity: 86.3%). NLR would be useful for the diagnosis of LN and reflects the severity of renal dysfunction Therefore, evaluating NLR before treatment could help clinicians to identify potential renal involvement in patients with SLE and distinguish LN from CN.

In this study, we aimed to investigate the prevalence of nonalcoholic fatty liver disease (NAFLD) in children with renal failure under treatment with dialysis and its association with biochemical measurements.

In this cross‑sectional study, children aged less than 18 years with chronic kidney disease (CKD) who were under treatment with dialysis at least 3 months ago were enrolled. To evaluate fatty liver in those patients who had no recent liver ultrasonography (last 6 months), liver ultrasonography was performed. The characteristics of patients with renal failure with and without NAFLD based on the ultrasonographic evaluation were compared. The association between NAFLD and the studied variables was evaluated.

In this study, 39 children (31 males and 8 females) with renal failure who underwent treatment with dialysis were included. From the studied population, six (19.4%) had NAFLD based on ultrasonographic evaluation. There were no differences between renal failure patients with and without NAFLD regarding the biochemical and anthropometric characteristics (P > 0.0).

The prevalence of NAFLD in our studied children with renal failure who underwent treatment with dialysis was like the general population and it was not associated with the biochemical and anthropometric characteristics of the patients. Given the importance of NAFLD in renal failure patients as well as its subtle nature, it is recommended to screen patients with CKD for NAFLD.

Chronic kidney disease (CKD) is a major public health concern in recent years mainly due to its adverse clinical outcomes. It is most commonly attributed to diabetes mellitus (DM) and hypertension (HTN). Among the several novel biomarkers discovered to detect impaired renal function, serum cystatin C (SCysC) has gained importance.

The aim of the study was to compare SCysC and serum creatinine (SCr) in CKD subjects and apparently healthy controls.

This case-control study comprising of 120 diagnosed cases of CKD and 40 controls was conducted at a tertiary care hospital. SCr and SCysC levels were estimated using modified Jaffe’s method and particle enhanced immunoturbidimetric method, respectively. Estimated glomerular filtration rate (eGFR) was calculated using CKD EPI formula. Comparison of SCr and SCysC between cases and controls was done using Mann Whitney U test. Pearson’s correlation test was used to study the correlation between variables. Statistical significance was considered at P<0.05.

Both SCr and SCysC levels were higher in cases compared to controls (P<0.001). In the group comprising of Stage 1 and Stage 2 CKD subjects, all the subjects showed normal SCr levels, while 96.8% of the subjects showed elevated SCysC levels. SCysC (r=-0.800) showed better correlation than SCr (r=-0.724) with eGFR (P<0.001). A strong correlation was found between SCysC and SCr levels (r=-0.887, P<0.001).

SCysC is a good indicator of renal dysfunction and may be used to screen patients with long duration of DM or HTN for CKD.

Acute kidney injury (AKI) is a common complication after coronary artery bypass grafting (CABG) surgery and can be linked to the increased morbidity and mortality. Therefore, in the present study, the effect of preoperative administration of acetazolamide was evaluated to investigate whether it could prevent occurrence of post-operative AKI after CABG surgery. In this randomized controlled clinical trial, 130 patients who were candidates to undergo elective CABG surgery from January 21, 2020 to February 8, 2021 were randomly allocated to intervention group (receiving 500 mg of acetazolamide orally 2 h preoperatively) and control group. The patients were evaluated for AKI based on the kidney disease- improving global outcomes (KDIGO) criteria based on their serum creatinine (SCr) level and urine output until 7 days postoperatively. There was no significant difference in baseline demographics between the two groups. The total incidence of AKI was measured as 43%. Analysis of post-operative AKI incidence showed no statistically significant difference between the two groups (P = 0.860). Mean post-operative SCr level on day 1 was significantly higher in the acetazolamide group (P = 0.036). A significant difference was found in length of hospitalization stay between the groups, which was higher in the control group (P = 0.006). Our results did not demonstrate a significant protective effect of acetazolamide on incidence of post-operative AKI in the patients undergone elective on-pump CABG surgery.

Different prescription entries usually complicate the drug therapy for critically ill patients; therefore, we conducted this prospective study to assess the rates for appropriate renal dosing modifications in chronic kidney disease (CKD) patients admitted to the ICU and reported possible related factors of misadjustments.

 We enrolled adult ICU patients who received at least one drug and experienced CKD with the estimated glomerular filtration rate (eGFR) ≤ of 59 ml/min on ICU admission. The latest Lexicomp drug information handbook recommendations were also applied as a standard guide for renal dosing changes.

A total of 701 prescription entries were studied in 97 patients, and 13.8% (97 medications) required renal dose adjustment. Of the 97 drugs, 20.6% (20) had not been prescribed appropriately, according to eGFR. Antibiotics were the most likely medication group to require a dose adjustment and comprised the largest number of inappropriate prescriptions in our study. EGFR and the number of drugs that needed dose modification significantly affected renal dosing adjustment accuracy (p = 0.03 and 0.01, respectively).

These results revealed a high percentage of appropriate renal dose adjustment in ICU compared to other studies that evaluated non-critically ill patients. However, more attention should be paid to patients with a higher number of prescribed medicines for renal dose modification and lower eGFR to reduce medication errors.

Mucormycosis is an opportunistic fungal infection that occurs primarily in immunocompromised individuals, usually affecting the rhino-orbital areas followed by the lungs. This case report presents renal mucormycosis in a young man after COVID-19 pneumonia that escalates the need for regular follow-up of COVID-19 patients. Post-COVID-19 fungal infections are on a steep rise, and the increased use of steroids and immune modulators for COVID-19-associated immune dysregulation and cytokine syndrome increases the risk among patients treated for COVID-19.