Nephro-Urology Monthly
Volume:13 Issue: 3, Aug 2021

 The current study intended to determine whether serum albumin level and urine protein/creatinine rate (uPCR) are appropriate predictors of severe lupus nephritis in childhood-onset SLE.

 Following a cross-sectional single-center design, 85 LN children referred to the National Children Hospital, Ha Noi, Viet Nam, from 6/2019 to 6/2020 were recruited. Renal biopsy was performed for all participants.

 Following a cross-sectional single-center design, 85 LN children referred to the National Children Hospital, Ha Noi, Viet Nam, from 6/2019 to 6/2020 were recruited. Renal biopsy was performed for all participants.

 The mean SLEDAI score of all patients was 14.69. The proportion of patients with high and very high SLEDAI was 61.2 and 17.6%, respectively. The mean concentration of serum albumin was 28.55 g/L, and the proportion of decreased albumin concentration was 55.3%. The median uPCR was 446.6 mg/mmol in which 76.5% of values were ≥ 200 mg/mmol. Pathological morphology of LN class from I to VI was observed in 0%, 17.6%, 37.6 %, 37.6%, 7.1%, and 0%, respectively. Serum albumin level and uPCR presented the predictive value for severe and active LN (class IV and V); (AUC: 0.725 P < 0.001 for both).

 Serum albumin and uPCR were appropriate predictors for severe and active LN in Vietnamese children.

 Erectile dysfunction (ED) and infertility are important health concerns with negative impacts on the quality of life and couple’s relationship, which is emerging as an early marker for decreased general health.

 This pilot study intended to investigate the prevalence and risk factors of erectile dysfunction in men of infertile couples referred to an in vitro fertility center in northern Vietnam.

 A total of 138 men of infertile couples were enrolled in this study from January to May 2018. The International Index of Erectile Function questionnaire scale was used to evaluate the severity of ED. Also, several related factors were collected to determine potential risk factors.

 The prevalence of ED among was 18.1%, including 13 mild ED (9.4%), 7 mild to moderate ED (5.1%), 2 moderate ED (1.4%), and 1 severe ED (0.7%). The logistic regression analysis showed that risk factors associated ED were smoking > 5 pack/years (OR = 3.16, CI = 0.98 - 10.18; P = 0.05), not graduating from junior high school (OR = 5.11; CI = 1.11 - 23.8; P = 0.03) and azoospermia (OR = 7.55; CI = 2.18 - 26.16; P = 0.001). We observed relatively high OR in men with smoking < 5 pack/years (OR = 2.51) and abnormal semen analysis (hypospermia, oligozoospermia, asthenozoospermia, or teratozoospermia) (OR = 2.36), but there was no significant difference compared to the reference group.

 In the present study, the prevalence of ED among men of infertile couples was higher than non-infertile men. Low level of education, smoking for a long period, and azoospermia were the main risk factors of ED in men. Further large-scale studies are needed to extend the results.
 

 Chemotherapy-induced nausea (CIN) is one of the most common and uncomfortable symptoms in cancer patients, and different factors can be associated with it.

 This study aimed to determine different factors associated with CIN in cancer patients.

 A total of 144 cancer patients were selected by convenience sampling. The patients at acute phase of chemotherapy were assigned to case group (n = 58) if they had nausea or to control group (n = 86) if they did not have nausea. The patients' data were collected using a researcher-made questionnaire including items on potential factors for CIN through interviews with the patients and according to their medical records. Logistic regression models were used to conduct data analysis, and the correlations in question were expressed as odds ratio (OR) at 95% confidence interval (CI).

 The results showed that the chance of nausea increased by 6.4, 2.4, 1.2, and 1.5 times in case of expected nausea, pain, carbohydrate intake, and smelling a specific odor, respectively. The increasing nausea-inducing effect of drugs led to increased chance of post-chemotherapy nausea (OR = 2.366).

 Having pain, expecting nausea, carbohydrate intake, smelling a certain odor, and high emetogenic potential of chemotherapy are effective in the development of CIN.
 

 Detecting significant renal injury in an accurate and timely manner in acute kidney injury (AKI) patients who are critically ill remains controversial. Serum creatinine (Cr) is an important marker of kidney function in clinical practice, and its limitations are well known.

 This study aimed to evaluate neutrophil gelatinase-associated lipocalin (NGAL) as a marker of the early development of AKI in critically ill AKI patients.

 This prospective study was carried out at JSS Hospital, Mysuru, India. The diagnosis and staging of AKI was done according to the RIFLE criteria.

 A total of 53 critically ill patients were enrolled in this study. During Intensive Care Unit (ICU) stay, 34 (64.2%) patients developed AKI according to RIFLE criteria. Serum NGAL levels assessed on admission were an appropriate predictor of AKI com-pared to serum Cr. Serum NGAL levels also showed a significant elevation among AKI patients than non-AKI cases. The mean levels for AKI patients at 0, 4, and 8 hours were 870.53, 1074.9, and 1090, respectively. Meanwhile, the mean levels for non-AKI patients at 0, 4, and 8 hours were 337, 307, and 292.

 Measuring serum NGAL on admission is useful in the early diagnosis of AKI com-pared to serum Cr.

 Malnutrition is common in patients undergoing hemodialysis and leads to a decrease in dialysis adequacy. The evaluation of dialysis adequacy is very important.

 This study was done to investigate the relationship between patients’ nutrition status based on Subjective Global Assessment (SGA) and their dialysis adequacy.

 This cross-sectional descriptive study was conducted in Tehran, Iran, in 2019. Three hundred qualified patients were selected by cluster sampling. Before the dialysis session, measurement of height and weight and blood sampling for albumin, total iron-binding capacity (TIBC), blood urea nitrogen (BUN), and creatinine (Cr) assessment were performed. After the dialysis session, measurement of weight and second sampling for BUN were done. SGA forms were filled by patients. Patients’ dialysis adequacy was calculated based on the DaugirdasII formula, and data were analyzed using SPSS 21.

 From 300 patients, 128 cases (42.7%) had normal nutrition status, while 148 cases (49.3%) had mild to moderate malnutrition and 24 cases (8%) had severe malnutrition with mean dialysis adequacy of 1.07. The present study showed a significant statistical relationship between malnutrition and education (P < 0.001), body mass index (BMI) (P = 0.03), albumin (P < 0.001), TIBC (P < 0.001), and dialysis adequacy (P < 0.001). Gender, age, and dialysis duration showed no significant relationship with nutrition status based on the SGA index.

 The findings showed a high relative frequency of malnutrition and a decrease in patients’ dialysis adequacy, which emphasize the patient’s educational level, proper management of nutrition along with regular consultations by nutritionists, better implementation of the dialysis procedure, and regular follow-up of dialysis adequacy.

 Inflammatory processes are proved in patients with chronic kidney disease (CKD) as one of the leading causes of mortality and morbidity. N-acetylcysteine (NAC) is known as an antioxidant drug with anti-inflammatory effects.

 This study aimed to evaluate the effects of NAC on hsCRP in CKD patients on peritoneal dialysis.

 This quasi-experimental self-controlled study examined adult CKD patients on peritoneal dialysis referred to the peritoneal dialysis clinic. The participants were assigned into two groups (A: CRP of 5 - 15 mg/L and B: CRP < 5 mg/L), and both groups were treated with oral NAC 600mg twice a day for eight weeks. First, the hsCRP was measured before and after the intervention, and then all the collected data were analyzed.

 Forty patients (n = 24 in the group A and n = 26 in the group B) participated in this study. NAC decreased the hsCRP level in both groups (P = 0.001 in the group A vs. P = 0.002 in group B); however, the decrease was more prominent in the group A (P = 0.013). The hsCRP decrease was more significant in women (P = 0.002) in general and women in the group B (P = 0.02) in particular. The hsCRP variation had a significant relationship with the underlying disease (P = 0.009). There was no significant correlation between the hsCRP variation with age (r = -0.173, P = 0.285) and the duration of dialysis.

 The administration of NAC (600 mg, twice a day for eight weeks) significantly decreased the level of hsCRP in patients on peritoneal dialysis, especially in those with CRP = 5 - 15 mh/L. The decrease has no relationship with age and duration of dialysis; however, it was more highlighted in women.

Renal ectopy is a rare phenomenon, which its diagnosis may be delayed due to an asymptomatic condition. The ectopic kidney may even have a normal functional state; however, because of occurring kidney blockade, the risk for kidney stones and even failure may be raised. In many cases, the diagnosis is completely incidental and is based on the request of radiography and sometimes, CT scan even for other reasons. In the therapeutic approach, in cases of kidney blockage, or urine backing up to the kidney, the surgical intervention is highly recommended by excisional removing the mass. Herein, we described a case of ectopic intrathoracic kidney initially presented with mild respiratory distress that was ultimately diagnosed by CT scanning and removed surgically.

Context: 

Acetylcysteine is an effective treatment for acetaminophen poisoning. The preparation and dose calculation of acetylcysteine is associated with medical errors. The prevalence of this error is 34% globally.

Case report:

 A 15-year-old girl took an overdose of acetaminophen in a suicide attempt. Acetylcysteine intravenous was ordered. Due to the medication error by the nurse, she received a 10-fold overdose of intravenous acetylcysteine in both initial loading dose and maintenance dose, at first day. On the second day, the patient showed abdominal pain, nausea, vomiting, and elevated liver enzymes. Her hemoglobin, hematocrit, and platelet quickly decreased. Subsequently, she developed oliguria, anuria, and rising serum creatinine levels. The patient was diagnosed with uremic hemolytic syndrome. She underwent hemodialysis and was treated with plasmapheresis, blood transfusions, and platelets.

 The effects of acetaminophen poisoning and acetylcysteine overdose may be much more severe and have a greater impact on patient survival than each poisoning alone. Timely and accurate treatment measures can help prevent long-term side effects.

Parvovirus is one of the uncommon causes of anemia in a kidney transplant patient. We reported a kidney transplant patient with parvovirus infection who developed severe anemia three weeks after kidney transplantation. Suspicion of infections increased due to the decrease in erythrocyte level. The patient's anemia became normal with a decrease in the amount of immunosuppressant and treatment with intravenous immunoglobulin (IVIG). Parvovirus B19 infection should be considered in all patients with persistent anemia with or without graft failure after renal transplant.

 Vasculitis of the bladder and urethra is a rare disease. Its presentation, as a pelvis tumor, indicates the cancerous nature of the lesion. An incorrect diagnosis can result in the removal of the bladder.

 We described a 56-year-old woman (born in 1964) with a vesicovaginal fistula, which arose from vasculitis ANCA. Establishing the correct diagnosis was a long and complicated process. During diagnosis, a urogenital fistula was created due to the deepening of inflammatory necrotic lesions. Remission was achieved by pharmacological treatment. As a result, fistula surgical treatment became possible. An unexpected relapse of vasculitis was diagnosed based on the bladder emptying symptoms. Repeating the treatment resulted in a complete response. Eventually, we obtained a cure of regional vasculitis while maintaining the bladder and urethra, which translated into an increased quality of life for the patient.

 Correct diagnosis before surgery is of crucial importance. Combined pharmacology and surgery prevents removal of the bladder. Careful observation of symptoms allowed for the early detection of recurrent vasculitis.