Nephro-Urology Monthly
Volume:13 Issue: 1, Feb 2021

Patients with end-stage renal disease (ESRD) need adequate dialysis. Thus, identification of the ways to enhance dialysis adequacy is very important.

The present study was conducted to examine the effect of preparing a dialysis machine using a normal saline heparin method on the dialysis adequacy of hemodialysis patients.

This study was conducted in Hamadan in 2019. A total of 36 patients with hemodialysis were selected using convenience sampling who were assigned to the control and intervention groups. The hemodialysis machine was primed for one month using a routine method (control) and one month using a normal saline-heparin method (intervention). Urea reduction ratio (URR) and Kt/V indices were calculated at the beginning and end of each month in the intervention and control groups. Data were analyzed using paired and independent t-test.

In the normal saline-heparin group, KT/V showed a statistically significant difference before and after the treatment (P = 0.013), as well as an increase in the KT/V. The URR as the mean dialysis adequacy showed a statistically significant difference (P = 0.004) between the normal saline group and the normal saline-heparin group before and after the treatment. Moreover, URR in the normal saline-heparin group increased after the treatment. In the normal saline treatment group, KT/V and URR decreased after the treatment. In the normal saline group, URR decreased after the treatment.

Applying the hemodialysis machine preparation with a normal saline-heparin method increased dialysis adequacy in the patients who underwent hemodialysis.

 Percutaneous nephrolithotomy (PCNL) has experienced remarkable development and alteration since it was first described in 1976 by Fernstorm et al. It has also experienced miniaturization of equipment, improvement in operative systems, and refining renal access methods leading to the achievement of maximum clearance of stone while causing minimal morbidity. For example, in endourological practice, when the patient is subjected to PCNL, he traditionally needs programmed inpatient admission, as part of their recovery, it is applicable as an outpatient method in properly selected cases.

 We aimed at evaluating the safety and applicability of the outpatient PCNL procedure.

 This retrospective study was done on 210 cases of tubeless PCNL performed by a single urologist at our institute from January 2016 to January 2019. Patients’ mean age (134 males and 76 females) was 57 ± 11.8 years, and 7 patients aged 8 - 12 years. There were 71 pelvic or calyceal solitary stones, 62 non-complete staghorn stones, 17 ureteral stones, 32 renal + ureteric stones (simultaneous renal and ureteral stones) , and 28 complete staghorn stones. The average stone size was 3.5 ± 2.8 (range: 0.7 to 11.8 cm).

 The mean operation duration was 85.0 ± 29.4 min, and the mean hospital stay was 21.7 ± 3.4 h. Out of 210 patients, 6 patients had longer stay due to high-grade fever and 3 patients due to severe pain, and also 7 patients refused discharge due to personal and social reasons. Our ambulatory PCNL rate was 97 % ( 194 out of 210). Within 72 h, 5 patients were readmitted due to high-grade fever, 3 patients due to haematuria, and 4 patients due to pain and dysuria, and all patients were discharged 2 - 4 days after conservative treatment. Thus, the readmission rate was 6.18% (12 cases were readmitted out of 194 cases). Patients showed a blood transfusion rate of 1.4 %. Also, 19 cases (9.02%) were found with post-operative fever, and no urosepsis was reported. No pulmonary complications and mortality were noted. No re-exploration was done, and no major leak was noted. The angio-embolization rate was 0.59%. We did not use HEMO-SEAL technology, cautery, or suture in the tracks.

 In conclusion, the outpatient PCNL procedure is an applicable and feasible procedure under selected criteria; however, more investigations using a larger sample size are needed.

 Proper use of nursing models and theories is an important step in improving patient care standards and quality of life. The growing trend of kidney failure and subsequent kidney transplantation in the country shows the importance of creating a proper structure in nursing patient care for transplant patients and recognizing the stressors that affect these patients.

 This study aimed to investigate the ability of the Betty Neuman model to provide a comprehensive model for nursing care of clients undergoing kidney transplantation.

 This clinical and clinical study was performed on the client of the kidney transplant candidate based on the application of Betty Neuman system theory. During the data collection, the interactions between the client’s five variables were examined and the stressors and resources in the internal, inter, and extra-individual domains were identified. Nursing diagnoses were created in accordance with the North American International Nursing Diagnostics Association (2018 - 2018) classification, and then nursing interventions were designed and implemented at three levels of prevention.

 The results of the study of physiological, psychological, social, evolutionary, and spiritual variables, as well as interpersonal and extra-individual stressors, were 7 potential and actual nursing diagnoses.

 Designing and applying a nursing process based on this model is a holistic and systematic attitude toward the client that requires proper, efficient, and evidence-based nursing care but increases the need for nursing human resources.

 Kidney recipients often use a calcineurin inhibitor and a proliferation inhibitor after transplantation. The therapeutic drug monitoring for calcineurin inhibitor is more simple and feasible in clinical than proliferation inhibitor. In Vietnam, mycophenolic acid is a popular proliferation inhibitor used for transplantation patients. Although therapeutic mycophenolic acid monitoring is so important in treating kidney transplantation, the monitoring is still difficult to execute in Vietnam.

 This study aimed to determine the MPA concentration on Vietnamese renal transplant recipients.

 This observational study was conducted on 35 adult kidney recipients to evaluate the MPA concentration at five sampling time points (predose, 1, 2, 3, and 6 hours) on day 3, day 10, and month 6 after transplantation.

 Plasma MPA trough levels (C0) were 2.32 ± 1.47;1.58 ± 1.39; 2.29 ± 1.4 mg/L and the MPA-AUC0-12 h values were 50.1 ± 20.4; 41.9 ± 14.5; 60.3 ± 25.9 mg.h/L on day 3, day 10, and month 6. The number of patients who reached MPA-AUC0-12 h values of 30 - 60 mg.h/L was 18 (51.4%), 23 (65.7%) and 17 (51.5%) on day 3, day 10, and month 6, respectively. The number of patients who achieved the MPA C0 values of 1.5 - 2.5 mg/L was 15 (42.9 %), 14 (40%), and 10 (30.3%) on day 3, day 10, and month 6, respectively; and the linear correlation coefficients between AUC0-12 h and C0 were 0.652, 0.415, and 0.752, respectively.

 In renal transplant patients, the MPA-AUC0-12 h was lower on day 3 and day 10 post-transplantation than month 6 for the half dose of MMF or MPS. Therefore, MPA therapeutic drug level should be monitored usually in transplantation patients who use MPA.

 Inflammatory markers increase in end-stage renal disease (ESRD), especially in diabetic patients, and are positively correlated with cardiovascular mortality. Coenzyme Q10 (CoQ10), an agent with antioxidant properties, may be effective in reducing cardiovascular complications in hemodialysis patients. This study aimed to investigate the effects of CoQ10 supplementation on plasma C-reactive protein (CRP), homocysteine, and albumin in hemodialysis patients.

 Forty diabetic ESRD patients on hemodialysis for at least six months were evaluated in a double-blinded randomized clinical trial. The patients were randomly assigned to one of the two groups to receive either CoQ10 100 mg daily or placebo. In all patients, the serum levels of homocysteine, albumin, and CRP were measured before and after six months.

 The mean age of the patients was 60.3 ± 9.1 years, and 57.5% of the participants were female. There was no statistical difference between the two groups at baseline. Furthermore, no significant difference was observed in serum albumin (P = 0.843), CRP (P = 0.214), and homocysteine (P = 0.21) at the end of the intervention between the groups.

 This study showed that in patients with ESRD, using CoQ10 supplementation has minimal beneficial effects on serum albumin, CRP, and homocysteine levels.

 Urine volume less than 1 mL/kg/h is called oliguria. The treatment of these patients is very important.

 This study aimed to compare dopamine and drip Lasix in children with oliguria.

 This study was performed as a clinical trial in the NICU, PICU, neonatal and pediatric wards of Amirkabir hospital in Arak. Children with oliguria with less than 1 mL/kg/h during treatment were considered the study group. Sixty children who met the inclusion criteria were selected and randomly divided into two groups, including 30 children in the dopamine group and 30 children in the Lasix group. In the dopamine group, the drug was administered at a dose of 3 µg/kg/min, in the second group, drip Lasix was administered at a dose of 0.05 mg/kg/h.

 In this evaluation, after evaluating the patients in both groups, it was observed that mean ± SD of age was 2.76 ± 1.85 years, and 51.7% of children have female gender (P = 0.438). The mean ± SD of creatinine in children after receiving dopamine and drip Lasix was 0.87 ± 0.2 mg/dl (P = 0.0001) and 0.84 ± 0.17 mg/dl (P = 0.000), respectively.

 Both drip Lasix and dopamine improved the condition of patients with oliguria. In addition, there was no statistically significant difference between these two drugs, so both drugs could improve the condition of patients.

 Diabetic nephropathy occurs in 20 - 30% of diabetic cases globally, and microalbuminuria (MA) is the first symptom of this disorder. Some studies have suggested that there is an association between the serum magnesium (Mg) level and MA.

 Therefore, we investigated the association between the serum Mg level and MA in type 2 diabetes mellitus (T2DM) patients.

 We conducted a cross-sectional study on 122 subjects with T2DM. We categorized them into two groups of microalbuminuria (MA) and non-microalbuminuria (NMA) according to their urine albumin-creatinine ratio (UACR). MA was considered as a UACR of 30 to 300 mg/g. Participants were excluded if they had the following conditions: The age of under 16 years, cardiac, renal, or hepatic disorders, using corticosteroids, diuretics, Mg /calcium (Ca) supplements, and antiepileptic drugs, heavy physical activity within 24 hours before the test, pregnant and breastfeeding women, febrile patients, and patients who were unwilling to participate in the study. The analysis was performed using SPSS version 15. A P-value < 0.05 was considered significant.

 Among the patients, 50.81% were male. Also, the mean body mass index (BMI) of the NMA group was greater than the MA group (29.84 ± 5.64 vs. 27.31 ± 3.14, P-value = 0.003). Mg levels of the MA and NMA groups showed no significant differences (2.13 ± 0.42 and 2.10 ± 0.43, respectively; P-value = 0.67). Overall, data analysis provided no significant difference between Mg level and the urine albumin concentration between the MA and NMA groups (P-value = 0.21 and 0.81, respectively.).

 Serum Mg level and MA have no significant relationship. Further prospective studies are needed to assay this issue.

 Hematuria is a symptom with a prevalence of 0.5% to 2% in those aged 5 - 12 years. Different factors can influence the severity of hematuria, including vitamin A (as a micronutrient).

 The current study aimed to evaluate the therapeutic effect of vitamin A on hematuria in children.

 In this clinical trial study, 156 children aged 5 - 12 years with Idiopathic Microscopic Hematuria are studied. Participants were divided into two groups of treatment and control (each with 76 subjects). Those in the treatment group received vitamin A as a pearl of 25000 in 14 days, in addition to the routine treatment. The control group only received routine handling. The basic information of patients were recorded using an author-develop form by the supervisor and intern. Urine samples were collected on 14, 28, and 42 days. Data were analyzed using SPSS. Statistical significance was considered when P-value < 0.05.

 There was no significant difference between the two groups concerning gender (P = 0.202), age (P = 0.330), father's education (P = 0.152), mother's education (P = 0.392), father's occupation (P = 0.125), mother's occupation (P = 0.265), and numbers of children in the family (P = 0.209) variables. Hematuria status on days 14 (P = 0.014), 28 (P = 0.001), and 42 after treatment (P = 0.001) was statistically more positive in the vitamin A group. Hence, there was a significant difference between the two groups.

 Vitamin A can reduce idiopathic microscopic hematuria. Hence, vitamin can be used as an alternative treatment to treat idiopathic hematuria in children.

 Chronic kidney disease (CKD) rarely occurs at the same time as endocrine diseases such as adrenal failure. There are some reports of cases with acute kidney failure accompanied by Addison’s disease and adrenal crisis. The studied case was a patient with Addison’s disease referring with manifestations of AKI on CKD and hyperkalemia without hypotension.

 This report describes a 34-year-old man with the primary diagnosis of CKD and the subsequent diagnosis of Addison’s disease.

 Since renal failure is accompanied by hyperkalemia, the diagnosis of adrenal failure will be difficult in the case of no obvious hyponatremia and hypotension. Thus, it is necessary to carefully check the clinical and laboratory symptoms and high clinical suspicions in CKD patients.