Iranian Journal of Kidney Diseases
Volume:15 Issue: 2, Mar 2021

Living with chronic kidney disease (CKD) is associated with hardships for patients and their care-partners. Empowering patients and their care-partners, including family members or friends involved in their care, may help minimize burden and consequences of CKD related symptoms to enable life participation. There is a need to broaden the focus on living well with kidney disease and re-engagement in life, including emphasis on patients being in control. The World Kidney Day (WKD) Joint Steering Committee has declared 2021 the year of “Living Well with Kidney Disease” in an effort to increase education and awareness on the important goal of patient empowerment and life participation. This calls for the development and implementation of validated patient-reported outcome measures to assess and address areas of life participation in routine care. It could be supported by regulatory agencies as a metric for quality care or to support labelling claims for medicines and devices. Funding agencies could establish targeted calls for research that address the priorities of patients. Patients with kidney disease and their care-partners should feel supported to live well through concerted efforts by kidney care communities including during pandemics. In the overall wellness program for kidney disease patients, the need for prevention should be reiterated. Early detection with prolonged course of wellness despite kidney disease, after effective secondary and tertiary prevention programs, should be promoted. WKD 2021 continues to call for increased awareness of the importance of preventive measures throughout populations, professionals and policy makers, applicable to both developed and developing countries.

Solid organ transplant recipients are in high demand for developed immune-modulating agents to control allo-immune responses following transplantation. The immunosuppressive agents offer the recipients improved short-term graft survival; nonetheless, this benefit is tempered by unavoidable long-term adverse events of these medications. Active control of allo-response using therapeutic cell transfer has gained much attraction during the last few years. It is widely established that regulatory T cells (Tregs) control immune responsiveness to allo-antigens and contribute to the induction of tolerance. Here, it is aimed to review recent results regarding Tregs and chimeric antigen receptor (CAR) Tregs therapy in solid organ transplantation and discuss strategies to overcome technical challenges of developing successful Tregs/CAR Tregs therapy.

Idiopathic Nephrotic Syndrome is a multifactorial disease that accompanying with immune system dysfunction. Cytokines as potent immunomodulators have a key role in pathogenesis of the disease. We aimed to evaluate the association between TNFα -308G > A polymorphism with Idiopathic Nephrotic Syndrome and its effect on the response to steroid therapy.

This case-control study was performed on 168 patients with Nephrotic Syndrome and 153 healthy children. Genotyping of TNF-α rs1800629 (-308G > A) variant was detected by polymerase chain reaction restriction fragment length polymorphism method (PCR-RFLP).

The results revealed that there was no significant difference in allele (P > .05, OR = 0.92, 95% CI: 0.59 to 1.43) or genotype (P > .05, OR = 1.00; 95% CI: 0.62 to 1.65) frequency of TNF-α rs1800629 (-308G > A) between childhood cases of nephrotic syndrome and healthy controls. Also no association was found between genotype (P > .05, OR = 2.28; 95% CI: 1.03 to 5.04), and allele frequency (P > .05, OR = 1.93; 95% CI: 0.97 to 3.87) among the SSNS and SRNS groups.

Our results did not support any association between the TNF polymorphism and the risk of nephrotic syndrome in a sample of southeast Iranian population.

Introduction. We conducted a cross-sectional study on children with steroid-resistant nephrotic syndrome (SRNS) in a single center in Southern China. Methods. A total of 166 SRNS cases in the Paediatric Nephrology Center of the First Affiliated Hospital of Sun Yat-Sen University from September 1, 2006, to August 31, 2016 were retrospectively analysed. The inclusion criteria were: 1) age ≤ 14 years, 2) diagnosed with SRNS, and 3) without purpura nephritis, immunoglobulin A nephropathy, lupus nephritis, or another secondary nephritis. Incidences of primary/ late steroid-resistance and curative effects were analysed. Results. The median follow-up time was 4.64 (2.64 to 8.11) years. There were 67 cases of complete remission (CR) (40.36%), 46 cases of partial remission (PR) (27.71%), 31 cases of no remission (NR) (18.67%), 18 cases of end-stage renal disease (ESRD, 10.84%, including 7 cases of kidney transplantation), and 4 cases of death due to hematoma and severe infection after renal biopsy; renal failure after progression to ESRD; sepsis during glucocorticoid (GC) + Cyclosporine A (CsA) treatment; and multiple organ failure at the onset of disease, respectively. For the 8 cases with gene mutation, unnecessary drug treatment should be reduced due to their low responsiveness to immunosuppressive treatment. Female, patients with hematuria, primary steroid-resistance (PSR) type and histopathologic focal segmental glomerulosclerosis (FSGS) were more likely to have higher ESRD rate. Subgroup analysis of ESRD suggested that female patients and patients with PSR type were more likely to develop ESRD. Cox-regression analysis showed that female (HR = 3.04, 95% CI: 1.18 to 7.86; P < .05), without hematuria (HR = 0.36, 95% CI: 0.14 to 0.91; P < .05), and LSR type (HR = 0.17, 95% CI: 0.04 to 0.74; P < .05) were significantly associated with ESRD. Kaplan-Meier survival analysis also showed the same trends. Conclusion. Of the 166 SRNS cases, 68.07% of patients achieved CR or PR, 18.67% of cases had NR, 10.84% of cases developed ESRD, and 2.41% of patients died during follow-up. Female gender, hematuria, and PSR type were positively associated with ESRD.

Steroid-dependent (SD)/frequently relapsing (FR) nephrotic syndrome (NS) follows a relapsing and remitting course. It is also characterized by proteinuria and edema, which can significantly affect health-related quality of life (HRQOL) in children. This study evaluated the effectiveness and safety of a single dose of rituximab (RTX) as well as the impact of RTX on HRQOL in children with SDFRNS.

Sixteen children with SDFRNS were enrolled in the study. Each patient was administered a single intravenous dose of RTX (375 mg/m2). Effectiveness was defined as remission of proteinuria. The side effects of RTX were monitored. HRQOL was assessed using PedsQL™ 4.0 Generic Core Scales.

All the patients completed the study. Three SDNS patients and three FRNS patients discontinued treatment over 1 to 3.25 years of follow-up. Additionally, three SDNS patients and three FRNS patients experienced 1 to 2 relapses. The mean relapse-free period was 79.0 ± 77.6 days. The mean dosages of prednisolone and other immunosuppressants required were significantly lower (P < .05, < .001) six months after treatment with RTX compared with six months before treatment. Relapse rate was significantly reduced (P < .001) after treatment with RTX. Skin rash, hypotension, and fever were observed in one child. Total health score and physical, emotional, and school functioning were significantly higher six months after treatment with RTX (P < .001).

A single dose of RTX is effective and safe for children with SDFRNS and can improve HRQOL, especially physical, emotional, and school functioning

Detection of nephrolithiasis is readily possible in infants with the advent of new imaging technology. Vitamin D is routinely given to newborn infants shortly after birth during infancy. Vitamin D is known to increase urinary calcium excretion which may be responsible for the increased incidence of nephrolithiasis during infancy. To test this hypothesis we studied the serum level of vitamin D and renal handling of calcium in infants with nephrolithiasis .

In this prospective case-controlled study, we measured serum levels of vitamin D and calcium accompanied by urinary calcium level in infants between 1 to 12 months with nephrolithiasis who fed with breast milk and vitamin D supplement and compared these parameters with healthy infants without nephrolithiasis after matching for sex and postnatal age as the control group. All infants with nephrolithiasis were evaluated for metabolic disorders and other risk factors and positive cases were excluded from the study.

Fifty infants between 1 to 12 months with mean postnatal age 6.96 ± 2.29 months with nephrolithiasis and 50 control infants with mean postnatal age 6.94 ± 2.55 months were enrolled in the study. Mean serum level of vitamin D in the case and control groups was 41.49 ± 11.69 and 35.67 ± 6.76 ng/mL, respectively. Mean serum level of calcium in case group was 9.63 ± 0.32 vs. 8.59 ± 1.21 mg/dL in the control group. Mean urinary calcium- creatinine ratio (Ca/Cr) in the study and control groups was 0.15 ± 0.16 and 0.08 ± 0.02, respectively, Differences were statistically significant in all three variables (P < .05).

Routine consumption of vitamin D increases urinary level of calcium and in presence of other predisposing factors could accelerate the genesis of nephrolithiasis in infants.

Lupus nephritis (LN) is one of the most serious complications of systemic lupus erythematous (SLE). With no specific clinical or laboratory manifestation to predict response to treatment, this study was aimed to provide a panel of predictive biomarkers of response before initiation of treatment.

Liquid chromatography tandem mass spectrometry (LCMS/MS) analysis was performed on plasma and urine samples of 11 patients with biopsy proven proliferative LN at the time of biopsy. Unsupervised principal component analysis (PCA), orthogonal projection to latent structures discriminant analysis (OPLS-DA), gene ontology annotation and protein mapping were performed on 326 proteins in plasma and 1381 proteins in urine samples.

Samples of eight patients achieved complete remission and three reached partial remission were analyzed. The mean 24- hour protein excretion was 3259 mg/d and the mean eGFR was 87.73 cc/min. OPLS-DA analysis of plasma samples showed a clear discrimination for complete and partial remission patients. Twenty plasma proteins and ten urine proteins with the highest fold changes and AUCs were selected as candidate biomarkers (IGHV1-18, PI16, IGHD, C3, FCER2, EPS8L2, CTTN, BLVRB). This plasma and urine biomarker panel is involved in oxidative stress, acute inflammation, reduction in regulatory T cells, complement pathway consumption, and proximal tubule bicarbonate reclamation.

Our suggested panel of plasma and urine biomarkers can precisely discriminate patients with possibility of complete response to treatment. It seems that the higher indices of inflammation will associate with better chance of achieving complete remission.

High serum concentrations of glucose, advanced glycation end products (AGEs), and hypertension are some of the major risk factors for cardiovascular disease and peritoneal membrane fibrosis in peritoneal dialysis (PD) patients. Some investigations in nonuremic individuals have indicated that isoflavones can reduce serum glucose, blood pressure, and increase insulin sensitivity. However, such study in this field in PD patients is still lacking. Therefore, we aimed to determine the effects of isoflavones on serum glucose, fructosamine, AGEs, and blood pressure in PD patients.

This study was a randomized, double blind, placebocontrolled trial. Thirty-eight PD patients were randomly assigned to either the isoflavone group or the placebo. The patients in the isoflavone group received 100 mg/d soy isoflavone for 8 weeks, while the control group received corresponding placebo. At baseline and the end of the 8th week, 7 mL of blood was collected from each patient and serum glucose, fructosamine, carboxymethyl lysine, pentosidine, accompanied by systolic and diastolic blood pressures were measured.

Serum glucose and pentosidine reduced significantly in the isoflavone group at the end of 8th week compared with baseline (P < .05), whereas no statistically significant changes were observed in the placebo group. Serum carboxymethyl lysine, fructosamine, and systolic and diastolic blood pressures did not significantly change within each group during the study.

This study indicates that soy isoflavones could decrease serum glucose and pentosidine in PD patients.

Mean Platelet Volume (MPV) has been revealed to be a risk factor for ischemic heart disease in the hemodialysis patients .The aim of present study is to investigate the association between MPV level with inflammatory and nutritional factors in patients requiring chronic hemodialysis.

100 patients who were on maintenance hemodialysis were included. Based on the median MPV (8.7 fL) patients were divided into two groups of low and high MPV level to assess and compare in terms of inflammatory (erythrocyte sedimentation rate, C-reactive protein, and transferrin), and nutritional (albumin, ferritin, uric acid, blood urea nitrogen, creatinine, triglyceride, cholesterol, low density lipoprotein, and high density lipoprotein) parameters.

The median MPV level in our patients was 8.7 ± 1.8 fl. There was no statistical difference in the level of inflammatory and nutritional markers between the two groups, and none of them were related to MPV level (P > .05). The prevalence of IHD was significantly higher in the high MPV group (P < .05). After adjustment for the age, no association was observed between different parameters and MPV level except for transferrin in patient’s ≤ 60 years old. Mean transferrin levels were significantly lower in the high MPV group (P < .05).

Present study did not show any association between inflammatory and nutritional markers with MPV level in hemodialysis patients except for the transferrin level in younger cases.

Pre-transplant serum phosphorus level is shown to be associated with some transplant outcomes in patients with chronic kidney disease. However, its association with Delayed graft function (DGF) has an aura of ambiguity. DGF means either the patient needs dialysis during the first week after transplantation or the creatinine level is ≥ 3. This study was aimed to assess the relationship between pre-transplant serum phosphorus levels with DGF.

A total of 306 patients, who had undergone kidney transplantation in the Montaserieh organ transplantation hospital in Mashhad, Iran, during 2016 to 2019; were enrolled in this study. Demographic data and clinical characteristics of patients including dialysis type and duration, donor type, medications, pre-transplant serum levels of calcium, phosphorus and DGF development were measured. Then, all patients were divided into five groups according to their serum phosphorus: P < 3.5, 3.5 ≤ P < 5.5, 5.5 ≤ P < 7.5, 7.5 ≤ P < 9.5, and P ≥ 9.5 mg/dL. The association with DGF was evaluated by statistical analysis.

Patients age ranged from 18.00 to 64.00 years old, with an average of 37.08 ± 10.9. About 55.6% of them were men, and 26.1% came up with DGF. Among patients with DGF, 36.25% were recipients with pre-transplant phosphorus level of 3.5 ≤ P < 5.5 and 50% of 5.5 ≤ P < 7.5.

Our study suggested that pre-transplant serum phosphorus might be associated with an increased risk of delayed graft function. Further studies are needed to assess, whether adjusting serum phosphorus level before kidney transplantation could reduce delayed graft function or not.

A 22-year old man underwent kidney transplant two years ago. Following fever and cough, epigastric pain, convulsion, vomiting and PO intolerance he had been brought to the emergency room. During evaluation in addition to pulmonary involvement with SARS-COVID-19, brain, stomach and pancreas involvements with COVID-19 infection also were detected. Hemodialysis and specific treatments were initiated. After 16 days he could be discharged ultimately.