Iranian Journal of Kidney Diseases
Volume:14 Issue: 6, Nov 2020

Coronavirus disease 2019 (COVID-19) has been recently emerged with various manifestations, mainly on respiratory system. However, other organs might also be involved. Acute kidney injury has been reported as a complication with high variability and controversial results. We aimed to define the frequency of AKI as well as two specific renal biomarkers including BUN and serum Cr among individuals suffering from COVID-19 infection. We investigated Medline/PubMed, Scopus, and Google Scholar databases until 16th April 2020 and included all relevant peer-reviewed published studies without any language limitations. We further categorized patients according to their clinical status into severe, non-severe, and death groups. 18 records on 4528 individuals were assessed. The mean age of individuals were 52.5 ± 24.4 years (males: 55.6%). Prevalence of AKI was 4% (95% CI: 2% to 8%) and was significantly lower among non-severe patients in comparison to deceased ones (1%, 95% CI: 0% to 4%, vs. 31%, 95% CI: 19% to 47%). BUN mean was 5.14 mmol/L (95% CI: 4.60 to 5.69). Non-severe patients had remarkably lower means of BUN compared to deceased or those with severe infection (4.25 mmol/L, 95% Cl: 3.70 to 4.79, vs. 8.9 mmol/L, 95% CI: 7.94 to 9.86, vs. 6.63 mmol/L, 95% Cl: 5.62 to 7.65; respectively). The mean serum Cr was 71.60 mmol/L (95% Cl: 67.56 to 75.64). Our findings suggest that COVID-19 does not seem to involve renal system extensively and other p

Introduction:

 The main causes of death in kidney transplant recipients are cardiovascular diseases and malignancy. This study aimed to determine the types of post-transplant malignancy, incidence, and related factors in renal transplant recipients referred to Razi Hospital in Rasht, Iran.

Methods:

 This retrospective cross-sectional study was conducted on 549 kidney transplant recipients between 1998 and 2018. Patient-, transplant-, and medication-related factors and pathology reports were recorded in the check list. Chi-square, T-test and Logistic Regression were used to investigate the effect of variables. Malignancy-person-year incidence rate was calculated using survival tables and Kaplan-Mayer analysis. 

Results:

43 (7.8%) recipients had malignancies. The most common site of malignancy was the skin (53.5%). Non-Melanoma Skin Cancer (NMSC) was the most common cancer (32.6%) followed by Kaposi sarcoma (20.9%). The standardized incidence ratio (SIR) of post-transplant malignancies in renal transplant recipients was 26.9 times the malignancies in Guilan province and 21.7 times the malignancies in Iran. Cox proportional hazard models identified older age at the time of transplantation and history of azathioprine consumption seems to be associated with risk for post-transplant malignancy.

Conclusion:

 The most common malignancies in these people were non-melanoma skin cancer, Kaposi sarcoma and then GI malignancies. According to the information obtained in this study, regular periodic examinations of kidney transplant recipients for early detection of malignancy is important.

Introduction:

 There is a mutual relationship between hypertension and renal failure, so that hypertension can be considered as a common finding in patients with end-stage renal disorders. Patients with persistent hypertension despite multiple medications are at high risk for adverse cardiovascular and kidney events. Some studies suggest that there is a correlation between RI and renal function in kidney diseases. Therefore, we conducted a study to investigate the relationship between renal arterial resistive index (RRI) and renal outcomes in patients with resistant hypertension.

Methods:

 This 2-years cross-sectional study was performed on patients with resistant hypertension. All patients undergo GFR, serum Cr and urine Alb tests. Then Doppler ultrasound was performed by a radiologist to measure RRI and was evaluated for the relationship between RRI and renal function.

 Among 133 patients with resistant hypertension, 57.5% were male and the rest were female. Average age of participants and average RI were 48.26 ± 16.90 and 0.63 ± 0.80, respectively. There was no significant relationship between RI and gender (P > .05). Relationship between RI index with age, GFR, serum creatinine level, and albuminuria was significant in all cases (P < .05). Patients were divided into two groups with RI ≥ 0.7 and RI less than 0.7. Results showed a significant increase in serum creatinine and urinary albumin excretion in group with RI ≥ 0.7 (P < .05), while age, protein exertion level, and GFR in the two groups were not statistically significant (P > .05), despite the difference in the mean. Results of analysis of difference in the mean RI in 3 groups (macro-, micro-, normo- albuminuria) showed no significant difference between them (P > .05).

Conclusion:

These data demonstrate the clinical importance of renal Doppler that may be an effective way to evaluate the prognosis of renal involvement in resistant hypertension.

To investigate the relationship between serum IgG (sIgG) concentration and the prognosis of IgA nephropathy (IgAN)

A total of 309 patients with biopsy-proven IgAN in the Second Referral Hospital of Shenzhen were enrolled between 2010/01 and 2017/06 Patients were divided into 3 groups on the basis of sIgG tertiles: < 899 g/L (Group G1), 899 to 1117 g/L (Group G2), and > 1117 g/L (Group G3)

As the level of sIgG increased, there was a decrease in DBP, serum creatinine, 24h urine proteinuria and an increase in serum albumin (all P < 05) In terms of pathological manifestations, with increasing sIgG levels, there was a tendency of decline in the Lee’s grading system or high-grade tubular atrophy/interstitial fibrosis or in the proportion of glomerular sclerosis and the ratio of crescent (all P < 05) Kaplan-Meier analysis indicated that the cumulative renal survivals rates were significantly higher in patients with elevated sIgG (P < 05) Cox regression analysis showed that after adjusting for gender, age, BMI, and clinical indicators (BP, 24h urine proteinuria, eGFR, M, E, S, T, and the ratio of crescent), decreased sIgG level at the time of renal biopsy is an independent risk factor for unfavorable outcomes in IgAN Furthmore, every 1 g/L decrease in sIgG level was associated with a 174-fold (95% CI: 130 to 538) increased risk of the incidence of composite renal outcomes

Decreased serum IgG level at baseline might be a kind of predictive marker for the poor prognosis of IgAN

Introduction:

 Children with malignancy who are under treatment with nephrotoxic drugs are at risk of renal dysfunction. Due to increased life expectancy, evaluation of drug toxicity is now of higher importance than before. The aim of this study is to compare two methods of GFR measurement.

Methods:

 An analytical study on children with malignancy undergoing chemotherapy with nephrotoxic drugs (cisplatin, carboplatin, cyclophosphamide, ifosfamind, etoposide) during 2016 and 2017 in Mofid Children Hospital was done. Demographic information, anthropometric measurements, type of malignancy, type of chemotherapy medication and also lab tests including CBC and the biochemistry indices were recorded. The GFR of each patient was calculated using Schwartz formula and DTPA scanning. The rates were compared and the difference was analyzed statistically.

Results :

According to Schwartz formula, 24% of patients needed dose adjustment, while based on DTPA scanning, this rate was 6%. Comparing these two measures by paired T-test, showed a significant statistical difference (P < .05). Schwartz formula had 25.5% more positive results of predicting the need for dose adjustment. The two measured GFRs for each person were evaluated in terms of compatibility and correlation based on Kappa statistical method, which were incompatible and had significant difference (P < .05).

Conclusion :

Using evaluative methods including Schwartz formula cannot demonstrate renal dysfunctions reliability in patients taking nephrotoxic chemotherapy drugs. Eventually if the GFR measurement method overestimates patients with renal dysfunction, the patients will not be able to make adequate use of the therapeutic effects of chemotherapy with the appropriate dosage.

Introduction:

 Serum immunoglobulin A (IgA)/C3 ratio has been reported as a predictor of histological lesions and prognosis in asian patients with IgA nephropathy (IgAN). Since its validity in other populations is unclear, we aimed to evaluate the relationship between IgA/C3 ratio and renal outcome in Caucasian European patients with biopsy-proven IgAN.

Methods:

 We conducted a retrospective, observational study on 95 patients with primary IgAN patients diagnosed between 2010 to 2017 (70% male, age 41 (34 to 49) years, eGFR 39.4 (25.2 to 56.5) mL/ min, proteinuria 1.7 (0.8 to 3.0) g/g). The primary study composite end-point was doubling of serum creatinine, ESRD (dialysis or renal transplant) or death, whichever came first.

Results:

 Median follow-up was 30 (95% CI: 27.5 to 32.4) months; 11% developed ESRD, 10% experienced serum creatinine doubling, and 1% died. The endpoint was reached by 21% of the patients. They had lower eGFR, higher proteinuria and hematuria, and lower serum albumin. The distribution in Oxford classes was alike. The AUROC for IgA/C3 ratio was 0.60 (95% CI: 0.45 to 0.74) and generated an optimal cut-off of 2.91 (sensitivity 68%, specificity 55%). The mean event-free survival of the whole cohort was 5.2 (95% CI: 4.7 to 5.8) years. Patients with IgA/C3 ratio < 2.9 had a tendency to better renal survival (P > .05). In Cox proportional hazard ratio model, the independent predictors of a poorer eventfree survival were higher serum creatinine, higher proteinuria and increased IgA/C3 ratio, while renin angiotensin system inhibitors predicted better outcome.

Conclusion:

Our study reports evidence that supports IgA/C3 ratio as a reasonable predictor of IgAN prognosis in European patients.

Introduction:

 Nephrotic syndrome (NS) is the most common chronic kidney disease in children. Patients who do not respond to steroids are steroid resistance nephrotic syndrome (SRNS). Cyclophosphamide (CP) has been used in the treatment of SRNS, but its effectiveness has been questioned. The aim of this study was to evaluate the drug response and side effects of CP in the treatment of SRNS.

Methods :

This study performed as a historical cohort (1997 to 2017) in idiopathic SRNS patients over one year of age who did not enter remission and used oral. All patients were followed up with CBC and regular visits to control drug side effects.

Results:

 In this study, 52 SRNS patients with a mean age of 5.3 ± 5.3 years were studied, of whom 24 (46%) were male and 22 (54%) were female. The follow-up period of patients was 1 to 264 months. In this study, 38.5% of patients were sensitive to CP and 61.5% of patients were resistant to CP. The response to CP was not significantly different between the ages of higher 6 years and under (P > .05). There was no significant relationship between remission rate and type of pathology and CP addition to treatment. But there was a significant difference between ESRD and CP resistance.

Conclusion:

 It can be concluded that CP has no significant effect on the remission of SRNS patients, but has made a significant difference in the development of ESRD in patients.

Introduction:

Diabetes mellitus and hypertension are described as the most common comorbidities among COVID-19 patients. We investigated the adverse effect of ACEIs in diabetic and nondiabetic patients with COVID-19.

 Methods:

This prospective study consisted of 617 RT-PCR-confirmed COVID-19 inpatients. Demographic and baseline characteristics, underlying comorbid diseases, and antihypertensive drugs were evaluated. Study outcome (in-hospital death) was evaluated with the Kaplan-Meyer method and Cox regression model. Statistical analyses were performed with SPSS software for Windows. P values < .05 were considered significant.

Results:

 Mean ± SD age was 58.49 ± 15.80 (range: 18 to 94) years old. Cox regression analysis revealed that age (adjusted hazard ratio [HR] = 1.04, 95% CI: 1.03 to 1.06), diabetes mellitus (adjusted HR = 2.07, 95% CI: 1.32 to 3.26), immunocompromised patients (adjusted HR = 2.33, 95% CI: 1.29 to 4.21), acute kidney injury (AKI) (adjusted HR = 3.23, 95% CI: 2.01 to 5.19), ICU admission (adjusted HR = 2.48, 95% CI: 1.46 to 4.21), Asthma and COPD (adjusted HR = 2.13, CI:1.6 to 4.28) and ACEI (adjusted HR = 3.08, 95% CI: 1.56 to 6.06), respectively were associated with in-hospital death. Among diabetic patients, ACEI (adjusted HR = 3.51, 95% CI: 1.59 to 7.75), AKI (adjusted HR = 3.32, 95% CI: 1.76 to 6.45) and ICU admission (adjusted HR = 3.64, 95% CI: 1.530 to 8.65) were associated with increased mortality. The Kaplan-Meier survival curve showed a lower survival rate in diabetic patients with ACE inhibitor (adjusted HR = 3.36, 95% CI: 2.25 to 7.71).

Conclusion:

 ACEIs may harm the diabetic patient’s outcome with COVID-19. Further studies can confirm if ACE inhibitors have an adverse effect on COVID-19 diabetic patient’s mortality.

To avoid temporary hemodialysis, urgent initiated PD (UIPD) has been designed. In these patients, PD is initiated within 3 days after PD catheter placement. In this study, we evaluated the outcomes of UIPD in end-stage renal disease patients compared with the conventional start of PD.

This is a single-center observational study, comparing outcomes of UIPD to conventional initiation of PD. All patients diagnosed with ESRD from March 2013 to February 2019 and were willing for CAPD were recruited. In UIPD group treatment was initiated at day 2 of catheter insertion with a dialysate volume of 1000 mL per dwell for 2 hours gradually increased to 2000 mL per dwell volume by 8 to 10 days.

During the study period, 98 patients were started on peritoneal dialysis in our hospital: 35 UIPD, 63 conventional PD. The mean age was 60.81 ± 13.04 years. 67% of patients were males with diabetes mellitus (32%) being the most common cause of CKD. Among the patients in UIPD, the mean age was 58.49 ± 16.1 years, while as in conventional group mean age was 62.10 ± 10.9 years. The Median follow-up time was 381 days. Technique survival was seen in 95 patients (96.9%). There was no difference in technique failure between UIPD vs conventional group. Total complications in our study occurred in 16 patients out of 98 patients during this period. There was no significant difference in the complication rates between the UIPD group and the conventional group.

Our study showed that catheter patency, technique survival, and catheter-related complications were comparable between UIPD and conventional start peritoneal dialysis.

L-Carnitine is a cardioprotective agent which balances metabolism by promoting mitochondrial β-oxidation and facilitating transportation of long chain fatty acids into the mitochondrial matrix It has been shown that L-Carnitine level in plasma and tissue is lower in hemodialysis patients and they may lose the benefits of this substance The aim of this trial was to evaluate the effects of L-Carnitine supplementation on cardiorespiratory Function in hemodialysis patients through ergospirometry

The current study was conducted on 46 chronic hemodialysis patients The patients were divided into two groups In both groups ergospirometry parameters (VE Max, VO2-Max and VCO2 Max, AT, VE/VCO2 Slope) were recorded for a 3-month period of time During this period, one group received L-Carnitine at doses of 2 g/d orally and the other group received only placebo After three months, all of the mentioned parameters reevaluated and statistical analysis was done 

Results:

 Only CRP value was different between two group and in placebo group increased significantly after 3 months (P < 05) No significant difference was detected in Cardio-respiratory factors In terms of ergospirometry, PET-CO2 was the only parameter which was significantly increased in the treatment group but decreased in placebo group (P < 05)

Conclusion:

Significant differences between our groups showed that L-Carnitine could help hemodialysis patients with cardiopulmonary problems to suffer lower rate of inflammation and poor life quality as shown at least in comparison of the two factors including CRP and PETCO2 at rest

Introduction:

 Atherosclerosis is associated with increased intima- media thickness (IMT) and vascular calcification (VC) in maintenance hemodialysis (MHD) patients. Fetuin-A is a serum protein, which inhibits vascular calcification. The aim of this study was to investigate the association between fetuin-A and VC, in a group of MHD patients. 

Methods:

 One hundred and forty-three MHD patients were included and followed for 3 years. Blood samples were studied for calcification and inflammation markers and fetuin-A was checked 3 times at the start, middle and the end of the study. We used common carotid doppler sonography for assessment of indices of VC, which were performed at baseline and at the end of the study. Vascular calcification was defined as a common carotid intima media thickness ≥ 0.8 mm on either side or the existence of any plaque or stenosis ≥ 50% on either side.

Results:

 From 143 patients (mean age 57.5 ± 15.9, 60.1% male), 104 patients (75.4%) had VC at baseline. The mean age and the prevalence of DM were significantly higher in patients with VC (P < .001 for both). There was no significant difference in the levels of Pi, PTH, and fetuin-A between the two groups. In a multiple logistic regression model at baseline only age (OR = 1.09, P < .001), and diabetes mellitus (OR = 4.59, P < .05) were associated with VC and dialysis vintage had a marginal association (OR = 1.20, P = .09). At the end of the study only age (OR = 1.12, P < .001), and CRP (OR = 1.14, P < .05) were associated with VC. The mean survival of patients with VC was significantly lower than the patients without VC (31.87 ± 0.95 vs. 33.73 ± 1.29, P < .05), however the mortality was not affected by fetuin-A level.

Conclusion:

 Survival rate of patients without VC was higher than the patients with VC. We didn’t find any correlation between the level of fetuin-A and VC. It seems that the traditional risk factors of VC, including age and diabetes mellitus are the main predictors of VC in MHD patients.

I n t r o d u c t i o n :

S i r o l i m u s ( R a p a m u n e ) i s a n i m p o r t a n t immunosuppressive drug in kidney transplant patients. The usual maintenance dose of Sirolimus in these patients is 2 to 5 mg/d and its optimal maintenance trough level is 5 to 10 ng/mL. The required Sirolimus doses may differ markedly from patient to patient. It is because of high inter and intrapatient variability in its pharmacokinetics. There have been no studies in Iran on the correlation of Sirolimus blood level and its target dose. This study has been done to show the target dose of Sirolimus in kidney transplanted patients in Isfahan.

Methods :

This is a longitudinal cross-sectional study conducted from June 2018 to September 2019. The study population included all kidney transplanted patients treated with Sirolimus in a nephrology private clinic. Inclusion criteria were age (equal or more than 18 years old) and the existence of complete data in the patient’s file. The participants were excluded if there were not at least two Sirolimus levels in the patient’s file. Demographics and other variables were extracted from the patient’s files.

Results:

Sirolimus was prescribed for seventy-three patients. Sixteen patients did not have the inclusion criteria. Fifty-seven renal transplanted patients were included in the study. The mean starting dose of Sirolimus in these patients was 2 ± 0.19 mg/d. The mean of the Sirolimus dose was 1.2 ± 0.44 mg/d. There was more than 20% GFR improvement in 68% of the patients after changing the Calcineurin Inhibitor to Sirolimus (P < .05).

Conclusion:

 In a significant number of patients changing CNI to Sirolimus accompanied by GFR improvement. Contrary to the recommended dose of Sirolimus in the references (2 to 5 mg/d) Iranian kidney transplant recipients needed lower daily doses of Sirolimus (1.2 mg/d) to achieve the desired whole blood level. Further studies are recommended to confirm it.

Introduction:

Calcium channel blockers (CCBs) are commonly used agents in the treatment of hypertension as part of monotherapy or combination therapy. Peripheral edema is the most common side effect that requires discontinuation or replacement of treatment. Some studies in the literature have shown that long-acting dihydropyridine type CCBs lead chylous ascites in peritoneal dialysis patients. However, amlodipine-associated serous ascites cases are not available in the literature.

Case Report:

 In this case report, we describe a rare case of amlodipine induced massive ascites in a 30-year-old male with renal transplantation.

Conclusion:

 We aimed to create awareness that pharmacologic causes should be considered in cases of ascites of unknown aetiology.