جستجوی مقالات مرتبط با کلیدواژه « Renal dysfunction » در نشریات گروه « پزشکی »

 Postoperative Acute renal failure related to cardiac surgery is a common complication due to cardiac surgery and is estimated to influence up to 30% of patients. Serum lactate is a famous biomarker of tissue ischemia and is regularly checked during surgery.

 In this retrospective observational research, the records of 395 patients undergoing CABG were examined. Patients were classified into 4 groups based on the difference between the maximum lactate level measured during surgery and its baseline level. Also creatinine and urea levels, blood sugar, hemoglobin, and hematocrit pre, postoperative were recorded. The intraoperative and postoperative use of inotropes and the durations of surgery, cardiopulmonary bypass pump, and aortic cross-clamping were also recorded.

 According to the results, pre, post and 24-hour postoperative blood urea nitrogen were not significantly related to intraoperative lactate changes. Also, pre and 24-hour postoperative creatinine had no significant relationship with intraoperative lactate changes, while postoperative creatinine was significantly associated with intraoperative lactate changes (P value=0.05). The duration of cardiopulmonary bypass (P value=0.02), intraoperative inotrope infusion (P value=0.03), inotrope infusion during the first six hours in ICU (P value=0.049), and receiving packed cell (P value=0.006) and receiving platelets during surgery (P value=0.04) were significantly related to intraoperative lactate changes. Furthermore, no significant relationship was observed between the duration of hospitalization in the ICU and the hospital and intraoperative lactate changes.

 According to the results, blood lactate level is an unreliable marker for predicting renal dysfunction postoperative.

Contrast-related acute renal failure is a multifactorial condition that involves oxidative stress, inflammation, and direct tubular toxicity. Risk factors for contrast-induced nephropathy comprise pre-existing kidney dysfunction, diabetes mellitus, advanced age, congestive heart failure, hypotension, anemia, and volume depletion. Preventive measures include identifying high-risk patients and implementing preventive measures such as adequate hydration, minimizing contrast use, and avoiding using contrast media in patients with pre-existing renal dysfunction. The systemic inflammation score is a promising tool for predicting contrast-associated acute kidney injury (CAAKI) in patients undergoing contrast-enhanced imaging procedures. Further studies are needed to validate the use of SIS in clinical practice and to better understand the underlying mechanisms of inflammation in (CA-AKI).

 Tenofovir alafenamide (TAF) has been effective against naïve patients with chronic hepatitis B (CHB) in phase 3 clinical trials. However, its real-world data are still limited.

 This study aimed to investigate the effectiveness and safety of TAF in real-life situations in treatment-naïve (TN) and treatment-experienced (TE) CHB patients in China.

 This retrospective study enrolled TAF-treated patients between January 2019 and October 2020 at the outpatient clinic of West China Hospital. The primary endpoint was the rates of virologic response (VR), and the secondary endpoints were the proportion of normal alanine aminotransferase (ALT) and quantitative hepatitis B surface antigen (qHBsAg) levels. Safety endpoints comprised serum lipid profiles, changes in estimated glomerular filtration rate (eGFR), and serum creatinine (Scr).

 A total of 161 TAF-treated patients were enrolled, including 49 TN patients and 112 TE patients. In the TN group, the VR rate at week 96 was 91.7% (22/24), and the proportion of normal ALT at week 96 was 95.8% (23/24). In the TE group, the VR rate at week 96 was 97.2% (69/71), and the proportion of normal ALT at week 96 was 90.1% (64/71). Serum qHBsAg levels decreased from 2930 to 1292 IU/mL in the TN group and 1158 to 533IU/mL in the TE group during 96 weeks of treatment (P = 0.05). For patients in the TN and TE groups, when compared to baseline measurements, serum creatinine increased (+7.91 vs. +6.62 mL/min/1.73m2, P = 0.52) while eGFR decreased (-11.46 vs. -10.90 µmol/L, P = 0.82) at week 96. Simultaneously, triglycerides (TG) (+ 0.39 vs. + 0.31 mmol/L, P = 0.32), total cholesterol (TC) (+0.65 vs. +0.52 mmol/L, P = 0.02), and low-density lipoprotein cholesterol (LDL-C) (+0.25 vs. +0.25 mmol/L, P = 0.60) increased over time.

 TAF was highly effective in TN and TE CHB patients. However, there are potential risks in eGFR decrease and a continuous increase in lipidemia with the prolongation of medication time.

The patients undergoing kidney transplantation are exposed to Intra-Abdominal Pressure (IAP) elevation following a surgery. The present study aimed to evaluate the diagnostic accuracy of the IAP measurement method via bladder in the prediction of renal dysfunction after kidney transplantation. This longitudinal study was conducted on 135 kidney transplant patients in two hospitals in Iran/Afghanistan from February 2019 to the end of October 2019. The patients' IAP was measured by nurses every 6 h up to 24 h after the surgery. The indices of renal dysfunction were utilized, including creatinine increase and urine reduction. Doppler ultrasound was used as a golden standard diagnostic test. Data were analyzed in STATA 14. Out of 135 patients, an increase in IAP>10 mmHg was observed in 9.5% of cases. Urinary loss and creatinine decrease more than 25% of baseline indicated a significant correlation with IAP mean difference (P=0.001) (4-1). Therefore, IAP could predict renal dysfunction based on the reduction of urinary volume and a decrease in creatinine of more than 25% of baseline. Finally, a comparison between the diagnostic power of the IAP measurement method and Doppler ultrasound indicated 90% of sensitivity and 94% of negative predictive value in predicting renal dysfunction.Implications for Practice: As evidenced by the obtained results, the IAP measurement via bladder catheter might be a primary test to predict renal dysfunction before Doppler ultrasound; nonetheless, further research is required.

In the treatment process of hypertriglyceridemia and diabetic nephropathy in type 2 diabetes, fenofibrate (FEN) is a well‑known medication. FEN is from fibrate class drugs that using orally; however, as a side effect, it is associated with serum creatinine level increasing. The aim of this review was to determine the real effect of FEN therapy on renal functions based on both experimental and clinical studies. For this review, using the keywords of “fenofibrate” and “renal” and “function,” a variety of sources of information banks, including PubMed, Google Scholar, and Scopus, were used, and the published articles were considered and interpreted. Followed by searching in databases, 45 articles were collected. After screening these articles, based on the study source, they were devided into two parts: 23 articles on animal experiments and 22 articles clinical experiments. Based on this information, it seems that the protective mechanism of FEN is related to vascular endothelial functions. The increased creatinine by FEN is related to different sensitivities to FEN effects caused by a polymorphism in different patients. In patients with normal renal function, follow‑up of serum creatinine would be necessary after FEN, but the discontinuation of FEN is not recommended. In addition, in diabetic patients with hypertriglyceridemia, FEN treatment would be suggested for protecting the kidney from diabetes‑induced renal injury.

The interrelation between cardiovascular diseases (CVDs) and renal dysfunction and the beneficial role of nutraceuticals are worthy to be studied. Nutraceuticals with anticancer effects are gaining great importance. The aim of this research was studying the anti-cancer, CVDs prevention and renal dysfunction properties of γ-oryzanol (γ-O) and rice bran oil/γ-O mixture (RBO/γ-O) as nutraceuticals.

Rats were divided into 7 groups. Group 1 was fed on balanced diet and served as normal control (NC). Group 2 consumed high-fat-sucrose diet (HFSD) as CVD control. Groups 3 and 4 were fed on HFSD and treated by γ-O and RBO/γ-O, respectively. Group 5 was maintained on HFSD with cisplatin injection (cardiorenal syndrome control) (CRSC). Groups 6 and 7 were treated like group 5 and given either γ-O or RBO/γ-O. Plasma lipid profile, malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), catalase activity, creatinine and urea were determined besides urinary creatinine clearance. Nutraceuticals’ anticancer effect was assessed in hepatocellular carcinoma cell (HepG2) line.

Significant increases (P<0.05) in lipid parameters with reduction of high-density lipoprotein cholesterol (HDL-C) were noticed in CVD control compared to NC group; the same changes were demonstrated in CRSC with lesser extent. In CVD control and CRSC groups; significant increase (P<0.05) in MDA and TNF-α with reduction in catalase were noticed. Kidney dysfunction was demonstrated in CRSC group. Administration of both RBO/γ-O and γ-O produced variable improvements in all parameters in both models and had anticancer effects.

RBO/ γ-O and γ-O had protective effects on CVDs and cardiorenal syndrome as well as anti-hepatocellular carcinoma activities with superiority of RBO/γ-O.

 Perivalvular and valve involvement are prevalent in patients with end-stage renal disease (ESRD), especially in younger patients compared with normal population. Kidney transplantation improves the prognosis of these patients. Patients with cardiac valvular disease is also be improved following kidney transplantation.

 To evaluate the impact of renal transplantation on the severity of mitral regurgitation (MR).

 We studied 95 kidney transplantation candidates in Sina Hospital. The patients underwent echocardiography preoperatively and at the 3rd, 6th, and 12th months post-operatively.

 Pre-operatively, the average MR fraction was 30%; MR volume 30 mL/beat; mitral valve mean gradient 1.8 mm Hg; mitral valve area 4.6 cm2; and mitral annular size 3 cm. No significant difference was observed among the measurements made at the 3rd, 6th, and 12th months post-operatively.

 There was no significant association between the variables measured pre- and post-operatively. The reason might be the fact that patients with ESRD in Iran do not have to expect long transplant waiting lists and dialysis cannot affect their heart adversely.

Chronic Kidney disease is a common condition seen in Juvenile diabetes with 90% of renal impairment patients displaying a wide spectrum of oral manifestations in the hard and soft tissues including changes of the salivary composition and flow rate. There is an increase in the serum cystatin-C, urea and creatinine levels in these patients, which is reflected in the saliva. This study was conducted to assess the changes in salivary levels of cystatin-C, urea, and creatinine as well as oral – Decayed, Missing and Filled Teeth Index (DMFT) and gingival indices in pediatric patients suffering from chronic renal disease and juvenile diabetes and compare them with healthy individuals.

Fifteen patients with juvenile diabetes suffering from chronic renal disease and 15 healthy controls aged 2-18 years were included in the study. Their saliva was analyzed for creatinine, cystatin-C and urea levels using an auto-analyzer and correlated with their existing serum levels. DMFT, gingival index, gingival bleeding and gingival enlargement indices were also assessed.

Increased levels of salivary cystatin C, urea (p value <0.001) and creatinine (p value =0.001) were seen in the cases. The deft value was significantly lower (p value <0.001) while the gingival index, gingival bleeding index, and gingival enlargement index were significantly higher in the subjects with renal impairment. 

Chronic Kidney disease results in many metabolic changes in the body, necessitating frequent biochemical blood analysis. Saliva, being a non-invasive, simple and rapid adjunctive tool, can be used for diagnosing and staging the disease and to check the progression of the condition.Keywords: Chronic Kidney Disease; Renal Dysfunction; Saliva; Cystatin-C; Diagnosis.

Spontaneous bladder rupture is a rare condition, and almost all the reported cases in the world have been preceded by bladder dysfunction, radiotherapy, urinary tract obstruction, pelvic surgery, inflammation, and malignancy.
Case report: In this study, we present the case of a 39-year-old woman (G: 4, P: 1, Ab: 2) who was in week 38 of pregnancy and attended our hospital with the onset of labor pain. She gave birth to a 3200 g infant through normal vaginal delivery. The patient attended with severe abdominal pain and oliguria four days after delivery. Ultrasonography showed massive abdominal fluid and bladder rupture. Regarding the rareness of bladder rupture during vaginal delivery, we introduced a case of bladder rupture following delivery. This case is important for midwives and gynecologists to gain more information about normal vaginal delivery complications to accelerate diagnostic and therapeutic interventions.

Renal disease is an important cause of morbidity and mortality in populations with HIV infection. Widespread use of combination antiretroviral therapy has altered the spectrum of renal disease. Studies among the HIV affected population in India are few.
The study was carried out to determine the various histopathological lesions in HIV patients with renal dysfunction, undergoing a renal biopsy, and to establish the clinico-pathological correlation. Patients and Thirty HIV-positive patients, diagnosed by enzyme-linked immunosorbent assay (ELISA) method according to the National AIDS Control Organization (NACO) guidelines, undergoing a renal biopsy for renal dysfunction were studied. Descriptive statistics were applied.
Rather than the classic human immunodeficiency virus associated nephropathy (HIVAN) or a few prototypical lesions, the cases were spread across the entire spectrum of glomerular and tubulointerstitial pathologies described in the HIV population. A higher proportion of diabetic nephropathy, IgA nephropathy and chronic interstitial nephritis were encountered in the present study.
In the present scenario of increasing incidence of HIV infection, studying its various manifestations are relevant. As none of the clinical or laboratory variables are found to predict glomerular versus non-glomerular lesions on biopsy, a renal biopsy is indicated in renal dysfunction associated with HIV, to make an accurate diagnosis and for therapy.

Thioacetamide causes lipid and kidney dysfunction.Omega-3 unsaturated fatty acids prevent the progression of renal diseases.
This study aimed to assess the protective effects of omega-3 fish oil supplement on thioacetamide induced lipid and kidney dysfunction in male rats.
In this experimental study, 42 male rats were divided into 6 groups of 7: control group sham group which received 0.4 mL olive oil as a solvent, Thioacetamide group receiving thioacetamide at a dose of 150 mg/kg once as intraperitoneal injection, Experimental groups of 1, 2 and 3 which received omega-3 fish oil supplement at the doses of 100, 200, 300 mg/kg orally for 3 months respectively and then they received thioacetamide at the dose of 150 mg/kg intraperitoneally for once. The levels of serum creatinine, BUN, total cholesterol, LDL, HDL, FBS, triglyceride, sodium and potassium were measured. The pathological changes of tissue samples of the kidneys were studied after hematoxylin-eosin staining. The data were analyzed by SPSS-18 software and using one way ANOVA and Tukey as post hoc test. Significant level was considered to be P The mean serum levels of potassium in the second experimental group significantly decreased (5.26 ± 0.02) compared to the group receiving thioacetamide (6.50 ± 0). The mean serum sodium in all experimental groups decreased significantly compared to the group receiving thioacetamide. The mean serum levels of total cholesterol in experimental group 3 (66.80 ± 1.46) significantly decreased compared to the group receiving thioacetamide (84 ± 0.57). No significant changes were observed in the mean serum levels of FBS, BUN, HDL, LDL, triglycerides and creatinine in all experimental groups compared to the group receiving thioacetamide. All the experimental groups improved renal histological changes induced by thioacetamide and these protective effects were dose-dependent (P ≤ 0.05).
The results of this study showed the protective effect of omega-3 fish oil supplement against thioacetamide induced lipid and renal dysfunction in male rats.

Fanconi syndrome is a metabolic disorder involving dysfunction of the renal proximal tubules, resulting in excessive urinary excretion of several metabolites. Various factors may lead to Fanconi syndrome, as it may be a genetic disease with primary or secondary etiologies, or may be acquired. In this study, we report a unique case of Fanconi syndrome with development of a relatively rare acute leukemia, a condition that has not been reported before. The case was an 8-year-old boy with familial occurrence of Fanconi syndrome, presenting with pallor, asthenia, recurrent infections, growth failure, and a variety of biochemical and hematological abnormalities. After physical examination, radiographic studies, and comprehensive laboratory analyses, Fanconi syndrome associated with bilineal acute leukemia, of myeloid and T-lymphoid lineages, was diagnosed.

This study was conducted to monitor the rate of inpatient mortality and its associated factors following open reconstruction of abdominal aortic aneurysm (AAA) in a tertiary hospital in Tehran, Iran. This retrospective study was a chart review of 112 patients undergoing open in­frarenal abdominal aortic aneurysm surgery in one of the main tertiary hospitals in Tehran, Iran. Baseline data (demographic data, risk factors) and outcome data (any cause mortality) were available in 106 cases, which included into this study. The inpatient mortality was very high (23.5%). Regression analysis revealed that in-patient mortality was higher in those with age over 70 years (OR=3.028, 95% CI= 1.099- 8.337) and those who developed temporary worsening of the renal function (OR=3.141, 95% CI= 1.071-9.21). High inpatient mortality rate of the AAA reconstruction in this study is alarming. The decrease in the renal function in the wake of infra-renal aortic surgery and also high age seem to be main risk factors of the increased inpatient mortality.

Focal segmental glomerulosclerosis (FSGS) is a type of nephrotic syndrome which is diagnosed by renal biopsy. Degree of the proteinuria, renal dysfunction, histologic findings and the response to therapy are some factors used for evaluating the prognosis of FSGS.. In the present study, we attempted to discover some protein candidates for disease prognosis related to glomerular filtration rate (renal dysfunction)..Patients and Urine samples were collected from ten patients. Urine proteome was extracted and trypsinated. Digested peptides were separated and identified by nano-flow LC-MS/MS. Protein content were determined using label-free quantification method. Protein profiles were analyzed using supervised multivariate statistical method.. Output of a predictive model was 54 significant proteins of which ribonuclease 2 and haptoglobin had the greatest fold change in terms of overrepresentation and underrepresentation in patients with the best and worse prognosis, respectively. Complement and coagulation cascades were the only significant pathways which were impaired in FSGS.. Urinary biomarkers can potentially be used as non-invasive prognostic markers. However these candidate biomarkers need further validation by an alternative method and in a larger cohort..

Despite the success of on-pump coronary artery bypass grafting (CABG) in the treatment of coronary artery disease, morbidity and mortality due to renal failure is a wellknown complication of this method. Currently, it is believed that off-pump CABG can be done with the same result and fewer adverse renal effects due to a lack of the use of the cardiopulmonary bypass machine. The aim of this study was to compare postoperative renal function between off-pump CABG and on-pump CABG. Sixty-seven consecutive candidates for elective isolated CABG were enrolled in this study and randomized into two groups. The on-pump group consisted of 34 patients and the off-pump group included 33 patients. All the patients were operated on via the same technique and surgeon. Blood samples were obtained before surgery and 6, 24, and 48 hours after surgery to measure the serum creatinine and assess creatinine clearance. Either 20% increase in the serum creatinine level or 20% decrease in creatinine clearance was considered as renal dysfunction. In the off-pump group, 5, 9, and 4 patients developed renal dysfunction 6, 24, and 48 hours postoperatively, respectively in comparison with 13, 22, and 11 patients of the on-pump group at the same time. There was a significant difference between the two groups regarding renal dysfunction 6 and 24 hours postoperatively (p value=0.038 and 0.003, respectively), but no significant difference was observed at 48 hours after surgery. We found no relationship between age and weight and postoperative renal dysfunction in either of the groups. Preoperative hypertension and diabetes had no effect on postoperative renal dysfunction. Renal function was better preserved in the patients undergoing off-pump CABG than on-pump CABG. Old age was not a risk factor for renal function but it could be a matter of debate and must be studied in future experiments.

Thrombotic thrombocytopenic purpura (TTP) is the most malignant variant of microangiopathy that usually presents by typical symptoms including thrombocytopenia, hemolytic anemia, neurological abnormalities, fever and renal impairment. Report of the Case: We report a 12-year-old male presented by cytopenia, fever, purpura on his extremities, seizure and lethargy. Peripheral blood smear revealed low platelet and increased schistocyte, but renal function tests were normal. Final diagnosis of TTP was confirmed by measuring ADAMTS-13 autoantibody (> 60). Atypical TTP can presents without renal impairment. In these cases the measurement of ADAMTS-13 activity as a specific test as well as ruling out secondary TTP should be considered.