Nephro-Urology Monthly
Volume:12 Issue: 2, May 2020

Using the marginal and expanded criteria organs increases the risk of ischemia-reperfusion injury (IRI), which remains unavoidable concerning issue after kidney transplantation (KT). While numerous trials have tested novel pharmaceutical approaches on animal models, little attempt has been made to assess the reproducibility of those results in the human setting. This study aimed to conduct a systematic review and meta-analysis to identify and abstract existing prophylactic strategies performed to reduce the risk of IRI after KT in human clinical trials.

 A comprehensive search was performed in MEDLINE, EMBASE, and Science Citation Index Expanded to detect relevant clinical trials until January 1, 2019. Two independent reviewers assessed the study eligibility, abstracted data, and evaluated the risk of bias. The prevention strategies in the included studies were categorized by one urologist. The fixed or random-effects model was selected based on the level of heterogeneity between studies in each category. The Cochran Q-test and I2 statistics were used to quantify the level of heterogeneity. The risk ratio (RR) of the delayed graft function (DGF) was calculated as the summary effect size of the primary outcome.

A total of 33 randomized controlled trials (31,334 patients) were categorized into seven groups based on the preventive hypotheses. Significant effects on DGF were observed in favor of the machine perfusion organ storage (RR = 0.73; 95% CI = 0.7 to 0.76; I2 = 0%) and use of antioxidant agents (RR = 0.6; 95% C = 0.46 to 0.78; I2 = 33%). There were no significant effects by innate inhibitors (RR = 0.86; 95% CI = 0.6 to 1.23; I2 = 58%), anti-inflammatory agents (RR = 0.86; 95% CI = 0.62 to 1.19; I2 = 0%), calcium-channel blockers (CCBs) (RR = 0.67; 95% CI = 0.3 to 1.49; I2 = 76%), conditioning (RR = 0.83; 95% CI = 0.59 to 1.16; I2 = 16%), and donor management techniques (RR = 0.88; 95% CI = 0.64 to 1.2; I2 = 57%).

This review supports the use of machine perfusion organ storage and administration of antioxidant agents. However, the clinical application of innate inhibitors, anti-inflammatories, CCBs, conditioning, and donor management techniques needs further investigations in large scales (PROSPERO number: CRD42019132985)

Primary hyperoxaluria (PH) is an autosomal genetic disorder characterized by abnormal glycosylate metabolism.

The aim of the present study was to assess post-transplant complications and survival of patients with PH who underwent either liver transplantation (LT) or simultaneous liver-kidney transplantation.

18 patients with established PH diagnosis who underwent LT or simultaneous liver-kidney transplantation in the Transplantation Center of Shiraz, Iran, were included. Demographic and clinical data were collected by reviewing clinical documents and interviews by the patients. The patients were prospectively followed up for the occurrence of the intended outcomes. The data was analyzed by SPSS 18 software.

12 patients (66.7%) were male, and six patients (33.3%) were female with the age range of 3 to 32 years (mean age, 18.89 ± 7.42 years). The patients’ weight ranged from 13 to 73 kg (mean weight, 47.39 ± 17.18 kg). Polyuria was the most common clinical presentation (11/18), and end-stage renal disease and hemodialysis were noted in 13 and 12 patients pre-transplantation, respectively. Hepatic arterial thrombosis, biliary complications, infections, and graft rejection comprised the most frequent post-transplant complications. Of 18 patients, seven patients (38.9%) died due to various complications during one year after transplant. Based on the Kaplan-Meier analysis, the survival rate was 61.1% at the end of the study. The mean survival time was 46.25 ± 18.6 months. The patients succumbed to the disease died within 3 to 320 days (mean, 61.57 days) post-surgery.

LT seems an effective intervention in prevention of kidney failure in patients with PH.

The present study was a retrospective cross-sectional analytical study.

This study was conducted on 301 hemodialysis patients referred to Hemodialysis centers in Hamadan in 2018. The tools for collecting information in this research are questions about demographic information (gender, age, educational level, occupational and housing status, marital status of the disease), and a checklist for the cause of chronic renal failure based on high blood pressure, diabetes, kidney disease, and other reasons. Chi-square, Fisher’s exact test, and ANOVA and SPSS version 24 software were used to analyze the data in the inferential statistics section.

The results of the study showed that blood pressure, other causes (trauma, drugs, lumbar surgery, etc.), kidney disease, and diabetes were the main causes of chronic renal failure in hemodialysis patients. Prioritization of the causes of chronic renal failure was due to other causes, unspecified causes (15.3%), history of surgery (6.3%), anemia (5%), trauma (4.3%), shock (7.7% 2%), viral diseases (2%), drug use and congenital causes (1.3%), and poisoning of pregnancy and lupus (0.3%) were among the most important reasons for end-stage renal disease (ESRD) in these patients; also subset renal diseases were the most important causes of chronic renal failure in hemodialysis patients, kidney stones (3. 3%), polycystic kidney (0.7%) and glomerulonephritis (0.3%), respectively.

According to the results of this study, it can be concluded that by promoting screening methods in patients at risk, prevention of end-stage renal failure can be prevented.

Kidney stones are one of the most common health problems in developed countries. A significant number of these populations experience recurrent stone formation with pain, urinary tract infection, or decreased parenchyma and renal function.

Accordingly, the aim of this study was to evaluate the effect of L-carnitine on 24-hour urine metabolites in patients with a history of recurrent stone formation.

This study was conducted on patients with recurrent stone formation. After the study samples were selected, they were provided with the necessary information about the study and their medical status. Demographic data and 24-hour urine indicators (including calcium, oxalate, uric acid, and citrate) were recorded before treatment. Patients were followed up for two weeks with no drug treatment and a regular food diet. At the end of the two weeks, 24-hour urine samples were collected and evaluated for calcium, oxalate, uric acid, and citrate. Patients were then treated with L-carnitine for eight weeks, with a dose of 1 gr daily. At the end of the eighth week, 24-hour urine samples were collected and evaluated for calcium, oxalate, uric acid, and citrate. Finally, the data obtained from this study were statistically analyzed.

34 individuals with a mean age of 39.5 ± 11.8 years participated in the study.11 patients (32.3%) were female, and 23 patients (67.7%) were male. The mean weight of the patients was 69.7 ± 10.6 kg of the mean size of the renal stones before and after treatment was 3.8 ± 3.1 and 3.6 ± 3.2 mm, respectively (P = 0.92). Moreover, the mean levels of uric acid, oxalate, citrate, and calcium before treatment were 748.3 ± 368.8, 28.9 ± 15.0, 945.5 ± 751.3, and 172.2 ± 116.1, respectively. The mean values of these urinary metabolites after treatment were 482.0 ± 266.7, 23.0 ± 13.1, 837.6 ± 609.9, and 134.8 ± 103.0, in the same order. A statistically significant decrease in the levels of uric acid, oxalate, and citrate is thus observed (P ≤ 0.05). Although calcium levels decreased after treatment, this reduction was not statistically significant (P = 0.08).

Treatment with L-carnitine, although did not result in a smaller size of the stones, decreased the urinary metabolite levels. This reduction may be effective in reducing the recurrence of stone formation.

Ultrasonography (US) is a safe and cost-efficient modality which is used to assess patients with urinary tract lithiasis.

In this study, we aimed to evaluate the accuracy of the twinkling artifact of color Doppler sonography in detecting renal stones smaller than 4 mm in diameter.

Of all patients referring to a tertiary medical center with a probable diagnosis of urolithiasis during April 2019 to September 2019, 99 patients with a renal stone smaller than 4 mm in non-contrast computed tomography (CT) scan entered our study. Both gray scale and color Doppler US were performed to assess the presence of any renal stones, the accompanying posterior shadowing, and the twinkling artifact for all patients.

Of 99 patients with confirmed renal stone on non-contrast CT scan, 91 patients had an echogenic focus on grayscale (sensitivity = 91.9%), 70 patients had posterior shadowing sign (sensitivity = 70.7%), and 76 patients had twinkling artifact on color Doppler US. The sensitivity, specificity, positive predictive value, and negative predictive value of this imaging finding for detecting renal stones smaller than 4 mm were 76.8%, 100%, 100%, and 32.4%, respectively.

Our study revealed that twinkling artifact on color Doppler US is a reliable sign for detecting renal stones smaller than 4 mm. However, the sensitivity of this sign could be increased in combination with gray scale findings (echogenic focus and posterior shadowing).

Problems with dialysis cause dramatic changes in these patients. Treatment of dialysis patients without the patient’s participation and self-care activities cannot be effective enough.

The aim of this study was to investigate the effect of telephone follow-up care on the quality of life of hemodialysis patients.

This clinical trial was performed on 60 hemodialysis patients in Hamedan, in two groups of tests and controls in 2018. Both groups of patients benefited from routine care and training in the ward, and then, in the test group, these patients were followed up by telephone for 6 weeks. The KDQOL-SF (short form) Demographic and Quality of Life questionnaire was used before and after the intervention to collect data. Data analysis was performed using SPSS 16 software using a t-test, paired t-test, and chi-square test.

The mean and standard deviation of quality of life in the experimental group changed from 52.33 ± 14.37 to 57.89 ± 12.02 and in the control group from 52.62 ± 13.05 to 41.85 ± 0.23 that indicates there was a significant increase in the quality of life of hemodialysis patients in the experimental group. The results showed that the average difference in quality of life after the intervention in the experimental group in terms of understanding public health (P = 0.002), physical performance (P = 0.002), symptoms and signs of the disease (P < 0.001) area of the disease, (P = 0.012), pain (P < 0.001), social support (P < 0.001 and general health (P < 0.001) were significant.

According to the findings of the study, it can be concluded that telephone follow-up care has been effective on the quality of life of hemodialysis patients.

We aimed to determine the parameters of acid-base balance in patients with chronic renal failure (CRF) and the relationship between the parameters evaluating acid-base balance and creatinine clearance.

The current cross-sectional study was conducted on 300 patients with CRF (180 males and 120 females). Clinical examination and blood tests by taking an arterial blood sample for blood gas measurement as well as venous blood for biochemical tests to select study participants were performed.

Patients with CRF in the metabolic acidosis group accounted for 74%, other types of disorders were less common. The average pH, PCO2, HCO3, tCO2 and BE of the patient group were 7.35 ± 0.09, 34.28 ± 6.92 mmHg, 20.18 ± 6.06 mmol/L, 21.47 ± 6.48 mmHg and -4.72 ± 6.61 mmol/L respectively. These parameters are lower than normal values and decrease by progressing chronic kidney disease (CKD) stage. These parameters correlated moderately with creatinine clearance.

In patients with CRF, metabolic acidosis is predominant, and acid-base balance parameters are positively correlated with creatinine clearance

The growing prevalence of Attention Deficit Hyperactivity Disorder (ADHD) and the non-medical use of Methylphenidate (MPH) among the youth have lead male infertility to be a major health problem.

The present study was conducted to investigate the impacts of MPH administration on different aspects of productivity, including total body weight, testis weight, spermatogenesis, sperm motility, histopathology changes, and sex hormone serum levels in male rats.

This study was performed with 54 eight-week-old male rats divided into one control and two experimental groups. The experimental groups were gavaged with 2 and 10 mg/kg methylphenidate daily while the control group was gavaged with normal saline (at the same dosage). After 60 days, rats were subjected to blood sampling and bilateral orchidoepididymectomy under anesthesia. Spermogram, histological, and hormonal evaluations were performed on the samples. Testes weight and total body weight were also recorded.

The results revealed significant differences between the MPH and experimental groups in terms of hormonal, spermographic, and histopathologic features, as well as weight. Luteinizing hormone and testosterone levels, sperm count and motility, Leydig cell hyperplasia, spermatogenesis, congestion and necrosis levels, total body weight, and testis weight were significantly different between the experimental and control groups. However, no difference was observed between the experimental and control groups concerning follicle-stimulating hormone, maturation arrest, and edema levels.

Based on the findings, MPH exposure exerts a significant effect on the testis and total body weight, as well as hormonal, spermatographic, and histopathologic characteristics. Accordingly, the present study provided an insight into the negative impression of MPH on sexual parameters