جستجوی مقالات مرتبط با کلیدواژه « Nephropathy » در نشریات گروه « پزشکی »

Diabetes is a multifactorial disorder that involves several molecular mechanisms and is still one of the key global health challenges with increasing prevalence and incidence. Gut microbiome dysbiosis could activate and recognize receptors that trigger the inflammation response and modulation of insulin sensitivity. In addition, the intricate role of gut microbiota dysbiosis in the onset and development of T2D (Type 2 diabetes mellitus) and associated microvascular complications was identified. These complications include diabetic nephropathy (DN) and diabetic retinopathy (DR), diabetic neuropathy, cerebrovascular disorders, and coronary heart disease. A recent interesting strategy to improve these complications is probiotics administration. The safety and health effects of probiotics against various diseases have been validated by various in vitro, in vivo and clinical studies. In this review, the related mechanisms between the gut microbiome, initiation, and progression of T2D and its common microvascular complications (DN and DR) have been discussed.

Kidney-liver crosstalk plays a crucial role in normal and certain pathological conditions. In pathologic states, both renal-induced liver damage and liver-induced kidney diseases may happen through these kidney-liver interactions. This bidirectional crosstalk takes place through the systemic conditions that mutually influence both the liver and kidneys. Ischemia and reperfusion, cytokine release and pro-inflammatory signaling pathways, metabolic acidosis, oxidative stress, and altered enzyme activity and metabolic pathways establish the base of this interaction between the kidneys and liver. In these concomitant kidney-liver diseases, the survival rates strongly correlate with early intervention and treatment of organ dysfunction. Proper care of a nephrologist and hepatologist and the identification of pathological conditions using biomarkers at early stages are necessary to prevent the complications induced by this complex and potentially vicious cycle. Therefore, understanding the characteristics of this crosstalk is essential for better management. In this review, we discussed the available literature concerning the detrimental effects of kidney failure on liver functions and liver-induced kidney diseases.

Psoriasis is a chronic inflammatory disorder, which affects the skin, nails, and joints. Psoriasis can be associated with systemic diseases such as diabetes mellitus, metabolic syndrome, renal diseases, and cardiovascular diseases.Renal involvement among patients with psoriasis has been increasingly reported. These disorders include conditions such as IgA nephropathy, membranoproliferative glomerulonephritis, secondary renal amyloidosis, and C3 glomerulonephritis. The various clinical and laboratory features that need consideration to rule out underlying renal disease in such patients include hypertension, edema of bilateral lower limbs, microscopic hematuria, and proteinuria.Herein, we present a case of a 49-year-old patient with chronic plaque psoriasis, who was diagnosed with nephrotic syndrome 8 years after the onset of psoriasis. Immunohistochemical analysis of the renal biopsy samples revealed membrane nephropathy with M-type phospholipase PLA 2R positivity.Due to the concurrent presence of severe psoriasis lesions, oral corticosteroid was deferred, and the patient was treated with oral Tacrolimus 4 mg per day for membranous nephropathy, which resulted in significant improvement of cutaneous lesions.

This study investigates the role of bile cast nephropathy (BCN) in acute kidney injury associated with cholestatic liver disease. Bile cast nephropathy is characterized by kidney injury due to, bilerelated factors, distinct from hepatorenal syndrome (HRS) linked to hemodynamic changes in liver disease. The mechanisms of BCN include oxidative damage, tubular toxicity, and obstructive physiology. Diagnosis is typically through biopsy, although alternatives like trans-jugular biopsy are considered due to bleeding risks. Treatment targets underlying causes of hyperbilirubinemia, and extracorporeal therapies like plasmapheresis and molecular adsorbent recycling system show potential efficacy. Awareness and further research on noninvasive diagnostic methods for BCN are recommended.

Elevated serum levels of osteopontin (OPN) have been associated with cardiovascular disease, diabetic nephropathy, and autoimmune disease activity. The aim of this study was to investigate the relationship between OPN serum levels and renal damage in type 2 diabetes patients. This analytical cross-sectional study was carried out in Yazd, Iran from April to September 2017. Micro-albuminuria and creatinine (Cr) in 750 patients were measured and 180 included patients were divided into the three groups of 60 subjects based on the level of micro-albuminuria; normal (group A), micro proteinuria (group B) and macro proteinuria (group C). Body weight, height, blood pressure, body mass index (BMI), HbA1c and OPN were assessed. Among 179 patients, 60 of them were normal for proteinuria, 59 patients had micro-proteinuria and 60 ones had macro- proteinuria. The mean age of participants was 58.96 ( ± 11.10) years (range 26-80 years), 90 patients (50.8%) were males and 88 ones (49.2%) were females. The mean OPN levels were significantly higher in group C compared to group B, and in group B compared to group A (P = 0.0001). Serum OPN was correlated positively with HbA1c (P: 0.012), Cr (P = 0.010) and glomerular filtration rate (GFR) (P = 0.002). There was a significant difference in the mean of OPN level among the subgroups with the history of ischemic heart disease (IHD) and HbA1C (P=0.035, and 0.047 respectively). These findings suggest that OPN is involved in chronic disease activity, and there is an independent association between plasma levels of OPN, and nephropathy in diabetic patients.

To evaluate the effect of fluorescein dye usage on renal function in patients with diabetic retinopathy (DR) and chronic kidney disease (CKD).

Diabetic patients with retinopathy who were candidate for fundus fluorescein angiography (FA) were evaluated for serum creatinine and urea levels within five days prior to performing the FA. Serum creatinine levels of 1.5 mg/dl or more in males and 1.4 mg/dl or more in females were both identified as CKD and were included in the study. An increase of 0.5 mg/dl or 25% in creatinine after FA was considered as contrast-induced acute kidney injury (AKI). Estimated glomerular filtration rate (eGFR) was also calculated for all patients using a CKD-Epi formula. CKD grading was determined based on eGFR values.

Forty-two patients agreed to participate, of which 23 (54.8%) were male. Seventeen patients were identified with grade 3a or lower CKD, 12 with grade 3b, 11 with grade 4, and two with grade 5 CKD. Considering all grades of CKD, the mean blood urea before and after angiography was 58.48 ± 26.7 and 57 ± 27.81 mg/dl, respectively (P = 0.475). The mean serum creatinine before and after the test was 1.89 ± 1.04 and 1.87±0.99 mg/dl, respectively (P = 0.993). The mean eGFR before and after the test was 44.024 ± 23.5447 and 43.850 ± 21.8581 mL/min/1.73 m2 (P = 0.875).

According to the findings of this study, FA does not seem to further deteriorate kidney function in patients with diabetic associated CKD.

Medical renal diseases stand as one of the major health problems in pediatric age group considering its morbidity/mortality and the subsequent management plans.

In this manuscript, the spectrum of histopathological patterns of medical nephropathic lesions in Egyptian pediatric patients over duration of five years is reported with clinical indications. Patients and

We conducted a retrospective study for analysis of our pathological reports of renal needle biopsies during the period from January 2014 until January 2019. One hundred and sixteen cases were included.

The most commonly encountered pediatric renal pathology was minimal change disease (27.59%), followed by congenital glomerular diseases (22.41%), focal segmental glomerulosclerosis (12.93%), and thrombotic microangiopathy (7.76%). The most common clinical indication for biopsy was nephrotic syndrome (37.07%) followed by impaired renal functions with elevated serum creatinine (21.55%). In addition, we report very rare histological findings in few cases including infantile nephropathic cystinosis, Barakat syndrome and C3 glomerulopathy.

Minimal change disease and congenital glomerular diseases accounted for half of pediatric renal pathologies in the study population. The most common clinical indication for renal biopsy was nephrotic syndrome. Electron microscopic examination and genetic studies are mandatory for proper evaluation of pediatric nephropathies.

Implication for health policy/practice/research/medical education:

this article reports a persistent dehydrated case with mild proteiunuria due to tubulointerstitial involvement that suddenly failed his renal function and underwent peritoneal dialysis.

Please cite this paper as:

 Jahangiri D, Ardalan M, Mubarak M, Alimohammadi S, Jahantigh HR, Saeifar S, Ragati Haghi Y. Chronic dehydration-related nephropathy; an under-recognized cause of renal failure in tropics. J Nephropathol. 2023;12(1):e18391. DOI: 10.34172/jnp.2022.18391.

 Doxorubicin is preferred to cure many malignancies. Its nephrotoxicity is a dangerous nature that is to operate with a warning. Antioxidants accompanied by anticancer could moderate the various side effects.

 Cichorium intybus (C. intybus) has nephron-protective effects. Melatonin stands as an antioxidant equivalent to others. The repairing effects of C. intybus-melatonin against the toxicity effects of doxorubicin on the kidneys were studied.

 Thirty 20 g to 25 g, balb/c mice were divided into 5 identical groups (n: 6). The research was grouped as control saline; DOX with the injection of doxorubicin; Chicory with the administration of the C. intybus complete extract following DOX; melatonin with the administration of the melatonin following DOX; both: with the administration of the chicory and melatonin following DOX. The histopathological study was set to determine degeneration, inflammation, and necrosis.

 The mean of each histological phenomenon in the control group was significantly lower than in the DOX group. In the histopathology, we saw that all the treating groups, including C. intybus extract-received, melatonin-received, both of them received improved better than the doxorubicin-received group. The best improving mean was seen in the latter group. The DOX-induced nephrotoxicity could be improved by using the C. intybus extract and melatonin synchronously as therapeutic care.

 Synchronous administration of the chicory and melatonin has a healing potency against doxorubicin-induced nephrotoxicity.

 Renal papillary necrosis (RPN) is a multifactorial complication that occurs under the following conditions: Pyelonephritis, obstruction of the urogenital tract, non-steroidal anti-inflammatory drugs (NSAIDs) abuse, diabetes mellitus (DM2), and coronavirus disease 2019 (COVID-19). The present report presented a case of right ureteral obstruction due to RPN.

 The patient was a 68-year-old woman referred to the hospital due to flank pain, fever, vomiting/nausea, frequency, and nocturia. She also had a history of DM2, hypertension, dialysis, COVID-19, and the use of NSAIDs and antihypertensive. The results of computed tomography (CT) scan suspected a clot, bladder fungus or RPN, and COVID-19. After performing the ultrasound, mild hydroureteronephrosis and two echogenic foci were seen in the right kidney, suggesting a possible RPN. The patient was transferred to the urology service. After cystoscopy and urethroscopy, a severe stenosis was seen in the distal right ureter. As soon as inserting double J, lots of pus came out. The definitive diagnosis was RPN, ureteral obstruction, and pyelonephritis.

 It is important to pay enough attention to the disorders related to the urinary system, especially in the elderly with a history of NSAIDs abuse, DM2, hypertension, COVID-19, and renal diseases. Additionally, the underlying diseases, blood glucose, infection, dehydration, and use of NSAIDs must be well-controlled to protect nephro-ureteral structures.

Accumulation of methylglyoxal (MGO) occurs in diabetes. MicroRNA-204 is an important intracellular marker in the diagnosis of endoplasmic reticulum stress. Crocin (Crn) has beneficial effects for diabetes, but the effect of Crn on MGO-induced diabetic nephropathy has not been investigated. The current research evaluated the effects of Crn and metformin (MET) on diabetic nephropathy induced by MGO in male mice.

In this experimental study, 70 male NMRI mice were randomly divided into 7 groups: control, MGO (600 mg/Kg/d), MGO+Crn (15, 30, and 60 mg/kg/d), MGO+MET (150 mg/kg/d), and Crn60 (60 mg/kg/d). Methylglyoxal was gavaged for four weeks. After proving hyperglycemia, Cr and MET were administered orally in the last two weeks. Biochemical and antioxidant evaluations, microRNA expression, and histological evaluation were assessed.

The fasting blood glucose, urine albumin, blood urea nitrogen, plasma creatinine, malondialdehyde, Nrf2, miR-204, and miR-192 expression increased in the MGO group. These variables decreased in Crn-treated animals. The decreased levels of superoxide dismutase, catalase, glyoxalase 1, Glutathione, and miR-29a expression in the MGO group improved in the diabetic-treated mice. Histological alterations such as red blood cell accumulation, inflammation, glomerulus diameter changes, and proximal cell damage were also observed.

Our study indicated that Crn and MET attenuated renal damage by inhibiting endoplasmic reticulum stress.

Diabetes mellitus is the most common childhood metabolic disease whose prevalence has been increasing worldwide in recent decades. Diabetic nephropathy is one of the most important chronic complications of both types of diabetes (type one and two), which seriously increases the morbidity and mortality of diabetes. The present study evaluated the epidemiology and risk factors of diabetic nephropathy in children with diabetes in the northwestern region of Iran.
In this cross-sectional study, 80 diabetic children, 33 (41.3%) males and 47 (58.7%) females with a mean age of 16.69± 4.50 years at the time of assessment, have been identified, evaluated, and followed up in the endocrinology clinic of Tabriz Children's Hospital from 2000 to 2015. The patients were divided into two groups based on the presence or absence of micro- or overt albuminuria, and different variables were compared between the two groups to determine risk factors.
The mean age at the diagnosis was 7.75 ± 3.69 and the mean duration of diabetes was 8.98± 4.07 years. Good glycemic control was presented in 19 (23.8%), microalbuminuria in 36 (45%), overt albuminuria in 1 (1.3%), and retinopathy in 5 (6.3%) of patients; 7 (8.8%) had hypertension. Chronic kidney disease was found to be stage I in 90% and stage II in 10% of the patients. There was a significant difference between cases with and without albuminuria in terms of age at the time of the study (p=0.003), duration of diabetes (p=0.02), and serum cholesterol level (p=0.04). Linear Regression test showed that «the age at diagnosis» has a significant ability to predict the incidence of albuminuria (p = 0.03).
Due to the significant frequency of poor glycemic control in children and adolescents and the high prevalence of albuminuria in them, it is recommended to evaluate the renal function in diabetic children, especially in older patients, those with longer duration of diabetes or poor glycemic control.

N-acetylcysteine is frequently used as an efficacious antidote for acetaminophen toxicity. It prevents liver injury induced by paracetamol and in most cases the overdose of acetylcysteine produces mild clinical effects.

Here we describe a patient who self-treated himself by acetylcysteine after acetaminophen toxicity. Approximately 5 hours after receiving 140 g of acetaminophen, the patient developed confusion, hypotension as well as seizures and also had coagulopathy and acute kidney injury. Other causes of these symptoms were overdose of acetaminophen and amoxicillin. Finally, the patient was treated by extensive supportive therapy and got healed.

This case suggests that massive IV acetylcysteine overdose can cause serious life-threatening conditions. The purpose of reporting this case is to increase the awareness among medical staff concerning adverse reactions revealed after a massive overdose of N-acetylcysteine and their arrangement as well as describing the way of management of such problems. The seizure was one of the manifestations in our case and it is so rare. This indicates that massive dosing of acetylcysteine could form irreversible damages in the brain, so it is very important to start the management as soon as possible and monitor patients precisely.

Type 1 Diabetes (T1D) is an autoimmune condition, in which the pancreas produces little or no insulin. Nephropathy is a serious T1D microvascular complication that is associated with high mortality and morbidity. 

This study aimed to investigate the prevalence of diabetic nephropathy and comorbidities in children with T1D.

This cross-sectional study was conducted on 208 children (aged 1–18 years old) with T1D who were referred to the Qazvin endocrinology clinic from 2017 to 2019. Anthropometric, demographic, laboratory, and comorbidities data were collected.

 The Mean±SD age at diagnosis of diabetes was 7.59 years, and the Mean±SD HbA1c level of the study subjects was 8.68±1.42 mmol/mol. Out of 208 diabetic patients, 64 cases (30.7%) had diabetic nephropathy, of whom 53 cases (25.5%) had microalbuminuria and 11 cases (5.3%) had macroalbuminuria. Among the studied diabetic patients, 30 cases (14.45%) had hypothyroidism, 12 patients (5.8%) had celiac disease, and 14 patients (6.7%) had anemia. Retinopathy was not found in any of the patients. Moreover, variables, such as the duration of diabetes, puberty status, mean HbA1c levels, and age were significantly associated with diabetic nephropathy (P<0.05). 

Mean HbA1c levels were significantly higher in patients with macroalbuminuria, which may corroborate the role of metabolic control of diabetes in the development of albuminuria.

The present study aimed at evaluating the association between the -429T/C and -374T/A polymorphisms of RAGE (Receptor for Advanced Glycation End Products) gene promoter and diabetic nephropathy as well as examining its possible application as candidate markers of diabetic nephropathy among the population of Qazvin, Iran.

In this study, the diabetic patients were divided into the two groups of with or without nephropathy. The frequency of genotype and allele were determined using TETRA-Primer ARMS-PCR. Hardy-Weinberg equilibrium test and correlation of polymorphisms, odds ratio (OR), and FAMHAP software were used for haplotype analysis.

Based on our data, the CC genotype of -429T/C polymorphism may play a protective role against the development of nephropathy (OR=0.586, 95%; CI: 0.158-2.167) while, the AA genotype may be associated with increased risk of the disease (OR=1.889, 95%; CI: 0.454-7.854). Allele’s analysis revealed that the C allele of -429T/C polymorphism maybe protective against the appearance of nephropathy (OR=0.794, 95%; CI: 0.48-1.314) whereas, the A allele may be related to increased risk for nephropathy (OR=1.452, 95%; CI: 0.783-2.695). Haplotype analysis demonstrated that there was no significant correlation between the two -429T/C and -374T/A SNPs (χ2=5.125, p value=0.135). However, it was found that the CA haplotype may have a protective effect against the development of nephropathy (OR=0.48, 95%; CI: 0.14-1.64) while, the TA haplotype may increase the risk of the disease (OR=2.06, 95%; CI:1.01-4.23).

Overall, no correlation between the -374T/A and -429T/C polymorphisms and the haplotypes in RAGE gene and the occurrence of diabetic nephropathy, was established.

Nephropathy is known to be the leading cause of kidney failure in diabetic patients. Troxerutin, as a flavonoid component, could provide a novel protective strategy in the prevention of diabetic nephropathy. A large number of reports on the salutary effects of troxerutin inspired us to investigate its effect on the nephropathy signaling events (i.e., expression of TGF-β, miRNA192, and SIP1) in type-1 induced diabetic rats.

50 male Wistar rats were divided into 5 groups including control group, sham group treated with troxerutin for 4 weeks, diabetic group induced by streptozotocin (STZ) injection, DI group including insulin-treated diabetic animals and DT group treated with troxerutin. Ultimately, rat kidneys were extracted, and the level of miR-192 (using qPCR), transforming growth factor-beta (TGF-β), and smad interacting protein 1 (SIP1) using an ELISA kit, was measured.

The level of TGF-β and miRNA192 significantly increased in the diabetic group. However, their expression levels decreased following the administration of troxerutin and insulin (p<0.05) compared to control group. SIP1 was down-regulated in the diabetic group, whereas a spike in the expression levels was observed after troxerutin administration compared to control and troxerutin groups (p<0.05). However, no significant difference was found in the effects of insulin and troxerutin on the level of miR-192, SIP1, and TGF- β.

According to the previous literatures, during the progression of nephropathy, TGF-β represses SIP1 (the repression region in the collagen gene) by increasing the expression of miR-192. Ultimately, in this study, diabetes led to up-regulation of TGF-β while troxerutin proved to have a protective effect on the kidney by increasing SIP and lowering miR-192 levels.

Contrast-induced nephropathy (CIN) is one of the most common reasons for acute kidney failure. Because of the increasing use of contrasts for computed tomography and angiography and coronary interventions, the incidence of CIN is on rise. CIN is a serious and common side effect ofthe use of contrasts. Despite taking of preventative measures, around 30-70% of patients are at risk of CIN. Researchers thus are seeking out appropriate approaches to prevent CIN. Positive effects of many medicinal plants, with antioxidant and anti-inflammatory properties and high efficiency and safety, in decreasing serum creatinine levels have been demonstrated. This study was conducted to collect evidence on the medicinal plants that are effective in decreasing serum creatinine levels and CINdevelopment

For this purpose, the key words contrast media, herbal, acute kidney injury, and nephropathy were used to retrieve relevant articles indexed in Google Scholar, Magiran, Elsevier, and PubMed. Then, the eligible articles were included in the review.

The results of studies are reported  in Table.

Although some studies have suggested that some herbs have a toxic effect on kidney function, in the present review, most plants could help decrease serum creatinine levels and improve renal function.