فهرست مطالب

Kidney Diseases - Volume:15 Issue: 3, May 2021

Iranian Journal of Kidney Diseases
Volume:15 Issue: 3, May 2021

  • تاریخ انتشار: 1400/02/28
  • تعداد عناوین: 13
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  • Alireza Mardomi, Hamid Tayebi Khosroshahi* Pages 161-167

    Hemodialysis (HD) patients display metabolic and immunologic alterations that renders their immune responses to be dysregulated. These patients generally have problems in mounting effective immune responses against pathogens such as viruses. On the other hand they typically have higher levels of inflammatory cytokines in their peripheral blood. Both of these features may work in favor of COVID-19. Since robust immune responses are needed to prevent infection in the initial stages of COVID-19, the impaired immune system may not be able to cope effectively with the highly replicating SARS-CoV2. In advanced stages of the disease wherein the inflammation as well as the cytokine storm are the core players, a high baseline inflammatory cytokines could intensify and substantially exacerbate the immunopathological situation. Presence of COVID-19 in HD patients may also be a complex immunological condition. Immunological alterations in HD patients and their potential effects on the fate of the SARSCoV- 2 infection are discussed here. Case reports describing the occurrence of COVID-19 in HD patients have also been reviewed in this study.

    Keywords: renal dialysis, COVID-19, cytokine releasesyndrome, inflammation
  • Kohkichi Morimoto, Tadashi Yoshida* Page 168
  • Xiaopan Chen*, Weili Cheng, Guangjie Wang, Yuanyuan Qi, Jing Xiao, Xiaoyang Wang, Zhanzheng Zhao Pages 169-176
    Introduction

    LN is an important complication affecting the prognosis of SLE. We retrospectively analysed the influence of thrombotic microangiopathy (TMA) on LN, identified risk factors of TMA in LN and renal failure in LN-TMA, and evaluated the availability of plasmapheresis.

    Methods

    After balancing epidemiological characteristics and pathological types between groups, 127 patients (LN-TMA:42, LN:85) were included. After consulting medical records and followup data, we used the corresponding statistical methods, such as chi-squared test and Student’s t-test, to compare differences in various aspects and explore the correlation among factors.

    Results

    LN-TMA patients had significantly higher blood urea nitrogen (13.2 mmol/L vs. 7.5 mmol/L, P < .001), systolic and diastolic blood pressures (both P < .01), serum creatinine (157.75 µmol/L vs. 79.00 µmol/L, P < .001), lactic dehydrogenase (P < .05), renal activity index (8.00 vs. 2.00; P < .001), SLE disease activity index score (13.8 ± 3.4 vs. 10.88 ± 6.0; P < .01), and pleurisy (P < .01) and lower haemoglobin (84.4 ± 20.14 vs. 99.38 ± 23.45 g/L, P < .05), platelets (87 vs. 155 ×109/L, P < .001), estimated glomerular filtration rate (39.24 vs. 97.40 mL/min/ 1.73m2, P < .05), and 3- and 5-year renal survival rates (P < .001 and P < .01, respectively) than nonTMA patients. Infection and TMA (P < 0.01) were independent risk factors for LN-TMA and renal failure, respectively. There was no obvious effect of plasmapheresis.

    Conclusion

    TMA is an independent risk factor for renal failure in LN. As TMA affects the severity and prognosis of LN, identifying specific diagnostic indicators and effective treatment for LN is necessary

    Keywords: lupus nephritis, prognosis, risk factors, therapeutics, thromboticmicroangiopathies
  • Gobind RamTarini Vats, Anil Kumar, Gulab Singh, Shiv Kumar Giri* Pages 177-189
    Introduction

    The mutational changes in Polycystin-1(PC-1) encoded by PKD1 gene is the main cause of Autosomal Dominant Polycystic kidney disease (ADPKD). The pathological changes in renal epithelial cells and multiple cyst formation occur due to activation of cascade of signalling pathways and membrane renal transporters (RTs). Our study have focused on the identification, of different RTs, their interactions with Polycystin-1 and other selected target proteins to find out their role in pathogenesis.

    Methods

    In this study, various RTs protein sequences were identified and retrieved from NCBI’s GenBank and UniProt. RTs were categorized according to different nephronal segmenta as per their functional information retrieved from UniProt and Transpoter databases. Further, sequences were subjected for interaction network analysis in String database and Cytoscape 3.7.2. Different interactions including experimentally validated were identified and can be further validated through in vivo methods.

    Results

    The cross talk between different RT, Polycystin-1 and other sequences were analysed. The various pathways of the interaction with PC-1 were categorised. The total number of 119 nodes and 769 edges interactions were generated. The results were visualized and cross verified with other databases in cytoscape.

    Conclusion

    The cross signalling of PKD1 with SCNN1A, SCNN1G, SLC12A1, AVPR2 shows their importance in the cyst formation and in pathogenesis of ADPKD.

    Keywords: kidney tubules, polycystic kidney disease 1protein, cysts, kidney, mutation
  • Gholam Ali Jafari, Reza Fotouhi Ardakani, Mohsen Akhavan Sepahi*, Jamileh Nowroozi, Mohammad Soleiman Soltanpour Pages 190-198
    Introduction

    Oxalobacter formigenes, as a gram-negative anaerobic bacterium, metabolizes oxalate in the intestine by the enzymes oxalyl-CoA decarboxylase (OXC) and formyl-CoA transferase (FRC). Therefore, not only the presence of the bacterium but also microbial load may affect intestinal absorption and urinary exertion. We evaluated the relationship between Oxalobacter formigenes load and the formation of calcium oxalate urolithiasis using quantitative molecular methods.

    Methods

    By clinical manifestation and stone analysis, we selected the urine and stool specimens of 73 patients with calcium oxalate urolithiasis. First, the gene regions of the two genes FRC and OXC in Oxalobacter formigenes were selected utilizing bioinformatics and specific primers designed for these regions. Following DNA extraction from stool specimens by specific primers of each gene, PCR was carried out and positive samples were sequenced. Then, qPCR was applied to determine the effective load of Oxalobacter. Also, biochemical tests were performed to measure the excretion rate of oxalate in urine specimens.

    Results

    In addition to oxalobacter identification by PCR, the load of bacteria was quantitatively assessed using qPCR by specific primers for both FRC and OXC gene regions. A significant negative relationship had found between the formation of calcium oxalate urolithiasis and the presence of Oxalobacter formigenes in patients with kidney stone disease. The mean excretion of oxalate and citrate in urolithiasis cases were 22.93 and 552.106 mg/24h, respectively.

    Conclusion

    The presence of Oxalobacter formigenes can highly inhibit the generation of calcium oxalate urolithiasis. Furthermore, molecular techniques are more effective than other methods such as culture for the isolation of this bacterium

    Keywords: Oxalobacterformigenes, calcium oxalateurolithiasis, oxalyl CoAdecarboxylase, formyl-CoAtransferase, quantitative realtime PCR
  • Suman Sethi*, Nitin Sethi, Jasvinder Singh Sandhu, Vikas Makkar, Simran Kaur, Preet M Sohal, Sudhir Mehta Pages 199-205
    Introduction

    Mineral bone disease is an important complication of chronic kidney disease ends up in increased cardiovascular morbidity and mortality in these patients. The aim of present study was to determine the pattern, prevalence and the clinical, biochemical and radiological profile of mineral bone disease in predialysis and dialysis (stage 5D) patients of chronic kidney disease.

    Methods

    Patients of stage 3, 4, 5 and 5D of chronic kidney disease admitted to the department of nephrology were enrolled in this study.

    Results

    200 patients of chronic kidney disease (19, 29, 43 and 109 cases of stage 3, 4, 5 and 5D respectively) with mean age of 52.4 ± 16.7 years and male to female ratio of 2.4:1 were enrolled. Diabetic nephropathy (45%), hypertensive nephropathy (33%), and chronic glomerulonephritis (14.5%) were the most common etiologies of chronic kidney disease. Proximal muscle weakness (91.5%) bone pain (59.5%) and pruritus (25.5%) were the common symptoms. Biochemical parameters showed hypercalcemia (19%), hypocalcaemia (55%), hyperphosphatemia (75.5%) and vitamin D deficiency in 84.5% of cases. High turnover bone disease was present in all predialysis and only 7% of dialysis patients. Adynamic bone disease was observed in 92.7% of dialysis patients. On univariate analysis i-PTH was significantly associated with sex, eGFR, serum calcium, and 25(OH) vit-D level and no association was found with age and FGF-23 levels.

    Conclusion

    Adynamic bone disease has emerged as the most common form of CKD-MBD in dialysis patients and secondary hyperparathyroidism being common in the predialysis patients of chronic kidney disease. Hyperphosphatemia and vitamin D deficiency were the most common reported biochemical abnormalities.

    Keywords: bone disease, chronickidney insufficiency, hyperphosphatemia, vitamin Ddeficiency
  • Siyi Liu, Mei Yang, Qing Zhao, Li Zhang, Qinkai Chen, Yu Wang* Pages 206-212
    Introduction

    Platelet-to-lymphocyte ratio (PLR) is widely used as an inflammatory marker and is associated with poor prognosis in some diseases, such as cardiovascular diseases and malignancies. However, the association between the PLR and all-cause mortality in peritoneal dialysis (PD) patients is unclear.

    Methods

    A total of 939 patients were enrolled. The X-tile program was performed to calculate the optimal cut-off values for the PLR, and the patients were divided into three groups according to the cut-off values: a low PLR group (< 108.33), medium PLR group (108.33 to 257.50), and high PLR group (> 257.50). Multivariate analysis was performed to assess the prognostic value of PLR. The primary end point was all-cause mortality.

    Results

    Of the 939 patients, the mean age was 49.9 years, and 57% of the patients were male. During a median follow-up of 27.5 months (interquartile range, 13.6-41.6 months), 221 (23.5%) died, in whom 114 (51.6%) deaths were attributed to cardiovascular mortality. Patients in the high PLR group had a higher mortality rate than patients in the low PLR group (log rank = 13.75, P < .001). The 1-year and 3-year overall survival rates were 88.9% and 71.7% for patients in the high PLR group compared with 98.6% and 86.2% for patients in the low PLR group, respectively. Similarly, multivariate Cox regression analysis showed that the mortality rate was higher in the high PLR group than in the low PLR group (HR = 1.64, 95% CI: 1.02 to 2.63, P < .05).

    Conclusion

    An increased PLR value was independently associated with all-cause mortality in PD patients

    Keywords: platelet-tolymphocyte ratio, mortality, peritoneal dialysis
  • Morteza Nabiee, Nasim Vahidfar, Simin Dashti-Khavidaki*, Mohammad-Reza Khatami, Mehrshad Abbasi, Mansoor Gatmiri, Mohammad-Hossein Shojamoradi, Neda Naderi, Azam Alamdari Pages 213-221
    Introduction

    Estimating glomerular filtration rate (eGFR) using different formulas is common clinical practice for evaluating kidney function and drug dosing. But, the performance of available eGFR equations is questionable during early days after kidney transplantation.

    Methods

    This study compared the performance of three common eGFR equations (Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)) in relation with measured GFR (mGFR) using clearance of Tc-99m-diethylenetriaminepentaacetic acid, 7 to 10 days post kidney transplantation. Agreement of mGFR and different eGFR equations in the staging of kidney function and dosing of 8 common antimicrobials were assessed.

    Result

    Thirty kidney and 5 simultaneous pancreas-kidney transplant recipients were included. CG applying total body weight (CGTBW) had the lowest bias (-12 mL/min/ 1.73 m2) and the highest percentage of estimation within 30% of mGFR (71.4%). MDRD showed the best precision (13.14 mL/min/ 1.73m2) and linear correlation with mGFR. CKD-EPI and MDRD acted better than CG for staging the level of kidney function. CGTBW had the lowest discordance rate with mGFR for antimicrobials dosing (33.6%). Discordance rates of drug dosing between mGFR and eGFR formulas were greater for drugs that have higher dosing levels such as (val)-ganciclovir (≥ 54.3%).

    Conclusion

    Until developing more accurate methods for estimating kidney function during first 1 to 2 weeks after kidney transplantation, CGTBW method is suggested for drug dose adjustment and MDRD or CKD-EPI equation for the staging of kidney function in these patients, keeping in mind that these formulas underestimate the level of kidney function in new transplant recipients.

    Keywords: . anti-infective agents, glomerular filtration rate, kidneytransplantation, kidney functiontests
  • Mahboobeh Freidoon, Fatemeh Pour-Reza-Gholi, Azam Alamdari, Farzaneh Sadat Minoo, Narjes Soleimanifar, Bita Ansaripour, Bahareh Mohebbi, Banafsheh Mosharmovahed, Fatemeh Fazeli, Mohammad Hossein Nicknam, Sara Assadiasl* Pages 222-228
    Introduction

    Renal transplant rejection is one of the clinical challenges, which usually requires administration of immunosuppressive drugs causing serious side effects. Therefore, invention of effective and specific therapeutics is necessary to control undesired immune responses particularly T-cell reactions to allograft. Interferon Regulatory Factor-4 (IRF-4) due to its implication on T cells differentiation and function might be targeted to treat T cell-mediated cellular rejection (TCMR). The aim of this study was to investigate the association between IRF-4 gene expression and acute TCMR, as well as to examine the correlation between IRF-4 gene expression and cellular expression of Programmed cell death-1 (PD-1) and Helios molecules.

    Methods

    Peripheral blood samples were obtained from 30 patients with biopsy proven acute TCMR and 30 stable recipients. IRF-4 gene expression was quantified using RT-PCR, and cellular expression of PD-1 and Helios were evaluated with flowcytometry.

    Results

    IRF-4 gene expression was significantly increased in acute TCMR patients compared with stable recipients (P < .05). Helios protein expression was slightly decreased in TCMR group but this was not statistically significant. There was a negative correlation between IRF-4 gene expression and PD-1 as well as Helios frequency in the whole studied population.

    Conclusion

    IRF-4 expression increases in acute TCMR which might also lead to a diminished expression of downstream immunoregulatory molecules such as PD-1 and Helios. Therefore, specific inhibition of IRF-4 may be helpful in managing acute TCMR.

    Keywords: transplantation, transplantrejection, interferon regulatoryfactor-4, programmed celldeath-1, IKZF2 protein
  • Amirhassan Rabbani*, Nooshin Dalili, Sadra Ashrafi, Katayoun Hassanzadeh, Shiva Aliabbar, Saman Nikeghbalian, Seyed Ali Malekhoseini, Aylar Nadiri Pages 229-234
    Introduction

    Continuous renal replacement therapy (CRRT) is an effective dialysis method in critically ill patients. Citrate and heparin are commonly used as anticoagulants to prevent premature circuit clotting. The aim of this study was to evaluate the safety and efficacy of using low dose systemic heparin while on CRRT in liver transplant recipients.

    Methods

    We retrospectively evaluated and analyzed data from 29 liver transplant recipients undergoing CRRT in the postoperative course in this cross-sectional study. Numerous variables were recorded, such as coagulation parameters, duration of intensive care unit (ICU) stay, duration of dialysis, heparin dose, circuit life span, and anticoagulant complications.

    Results

    Out of 29 recipients, there were 16 (55%) female and 13 (45%) male. All participants underwent whole organ liver transplantation with a median age of 45 years. Overall, 98 successful dialysis sessions were recorded in this study with a mean circuit life span of 36 hours. Mean ± SD duration of CRRT for each recipient was 4.8 ± 3.1 days. The median total dose of heparin used for each recipient was 25,000 units , and the median dose of heparin per-day for each recipient was about 3,300 units. There were no episodes of anticoagulant-related bleeding complications. Thirteen (13.2%) episodes of premature circuit clotting occurred. We found a significant association between the first dose and total dose of heparin usage with first postoperative INR and PTT level (P < .05, P < .05, P < .001, and P < .05).

    Conclusion

    In liver transplant recipients, low dose heparin during CRRT for patency of circuit is well tolerated.

    Keywords: continuous renalreplacement therapy, livertransplantation, anticoagulation, heparin, circuit life span
  • Sara Abolghasemi, Shahnaz Sali, Arad Mobasher Aghdam, Mohammad Amin Shahrbaf* Pages 235-237

    Mycobacterium abscessus complex is one of the most important groups of non-tuberculosis mycobacteria, which can cause infection in several organs of the human body. In this study, we report a rare cause of urinary tract infection which was presented with the chief complaint of hematuria and dysuria. The patient was treated by a clarithromycin based approach and the result of the culture and polymerase chain reaction were negative after 3 months of treatment. Informed consent was taken from the patient for publishing the case.

    Keywords: mycobacteriumtuberculosis, mycobacteriumabscessus, urinary tractinfection, steven-johnsonsyndrome
  • Alireza Heidary Rouchi* Pages 238-241

    Regenerative medicine has attempted to raise hopes to replace failing solid organs as a part of its wide-spectrum mission over the last couple of decades. To generate and implant an organ, taking the global challenge of organ shortage and histological complexity into consideration, has made this endeavor more taxing and strenuous in comparison with other subjects including cells and tissues. As the most prevalent transplanting organ worldwide, to make a kidney in laboratories using decellularized discarded donated kidney as a scaffold and recullalarize that with recipient’s native cells to circumvent another unavoidable obstacle, immunological mismatch, has remained a not yet attainable promise. Diversity of cell types and structural complexity of kidney with a range of functions has slowed down the pace of taking steps to fulfill this outstanding ambition, and, accordingly, it would make sense for the nonce that main attempts in limited-funding settings shall be directed to procure more allogenic grafts to partially meet the daily-expanding demands.

    Keywords: regenerativemedicine, kidneytransplantation, tissueengineering
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