Iranian Journal of Kidney Diseases
Volume:16 Issue: 1, Jan 2022

Nephrolithiasis is a common disease entity around the world, with an increasing prevalence and incidence. There is no consolidated information available on the cause of kidney stones in Iranian patients. As a result, we decided to review the etiology of kidney stones in Iran. PubMed, Scopus, Web of Science, Google scholar, and Scientific Information Database (SID) were searched with the following keywords “Nephrolithiasis”, “Renal stone”, “Kidney stone”, “Urolithiasis”, “Etiology”, “Metabolic abnormalities”, and “Iran”. There was no time period limit for selection of the papers. The inclusion criteria included any paper on evaluation of urine biochemistry regarding stone formation in Iranian adult patients (with or without children) with nephrolithiasis. We found 217 articles, of which 9 were eventually included. In conclusion, 1896 patients with nephrolithiasis from 6 provinces and 7 cities of Iran with different climates from 2000 to 2019 were evaluated collectively. The results showed that in contrast to western countries, hypercalciuria was not the most common biochemical disorder of patients with nephrolithiasis (18.2% vs. 30 to 60%). Low urine volume (49.6%) and hypocitraturia (27%) were the most frequent urine abnormalities in our country.

Administration of intravenous vitamin C in hemodialysis patients can reduce their ferritin levels. Nevertheless, little research has been carried out in this regard. Hence, this study aimed to determine the effect of intravenous vitamin C on ferritin levels in a group of hemodialysis patients.

The study population included 32 patients with chronic renal failure undergoing hemodialysis who had been referred to Qazvin Hospital. These patients had functional iron deficiency (IDA) and high levels of serum ferritin. Patients were randomly allocated into intervention group A (n = 16) and control group B (n = 16). Group A was given intravenous ascorbic acid, while group B was given the same amount of distilled water as a placebo three times a week after each dialysis session for three months along with erythropoietin. Laboratory parameters were assessed at the beginning and the end in an interval of three months.

In patients who received vitamin C injections, the mean ferritin level decreased at the end of the study (P < .05). But vitamin C intake did not affect BUN, creatinine, sodium, potassium, TIBC, hemoglobin, platelets count, and the length and number of dialysis sessions.

Results of our study showed that vitamin C can reduce serum ferritin levels in hemodialysis patients. Therefore, it can be used as an adjunct in the treatment of anemia in patients.

Elevated levels of interleukin 17A (IL-17A) have been found in systemic lupus erythematosus (SLE). Forkhead box protein P3 (FOXP3) activates T-regulation lymphocytes and is a master regulator of cell function. The cytotoxic T-lymphocyte-associated protein 4 (CTLA4) gene plays a similar role. We investigated the role of the expression of these genes in SLE patients with and without nephritis.

The present study was a case-controlled trial including 49 patients with SLE and 26 healthy controls. Gene expressions of IL-17A, FOXP3, and CTLA4 were measured by quantitative Real- Time PCR. The relation between lupus nephritis disease activity and IL-17A, FOXP3, and CTLA4 gene expression was evaluated.

IL-17A, FOXP3, and CTLA4 expression in T-cells were significantly higher in SLE patients than controls (P< .0001). When comparing the nephritis group and non- nephritis group with the control group, the expression of the mentioned genes was also higher (P < .05). There was no significant difference regarding IL- 17A, FOXP3, and CTLA4 genes expression in the nephritis group and non- nephritis group (P > .05). Nonetheless, there was a low expression of FOXP3 and IL-17A in patients with the higher stages of nephritis (P < .05).

Our findings showed that elevated IL-17A, FOXP3, and CTLA4 expression significantly correlate with SLE pathophysiology. This study provides new insight into the function of IL-17A, FOXP3, and CTLA4 in a disease setting. Heterogeneity of SLE patients is reflected in the multiple abnormalities found in the immune system. Finding such variations can provide targets for better manipulation of the immune system.

Association of constipation with incomplete bladder emptying, functional bladder outlet un-coordination, urinary tract infection (UTI), and upper urinary tract dilatation has been reported. We designed a study to determine the impact of chronic functional constipation on kidney and bladder ultrasound parameters, the results of the uroflowmetry test, and its association with UTI.

The study group consisted of 24 cases and 48 controls, who were children between 5 to 18 years-old, from June 2017 to June 2018. The case group included children with chronic functional constipation. The healthy children with urinary continence and regular bowel habits without any history of UTI were considered as the control group. The variables were bladder volume, post- voiding urinary residual volume, full and empty bladder wall thicknesses, uroflowmetry parameters and, UTI prevalence.

There were no significant differences in the prevalence of UTI, upper urinary tract dilatation on kidney ultrasound, uroflowmetry and, bladder ultrasound parameters between the case and control groups (P > .05 for all). We found abnormal uroflowmetry curves in 58.3% and 35.4% of the case and control groups, respectively (P > .05) and a higher rate of staccato curves in constipated compared to healthy children.

the prevalence of UTI and upper urinary tract dilatation on kidney ultrasonography are not significantly different between constipated and healthy children. Moreover, it seems that chronic constipation has no significant impact on the storage and emptying functions of the bladder. The higher frequency of staccato curves in constipated compared to healthy children can indicate that fecal mass causes detrusor sphincter dyssynergia.

Chronic kidney disease (CKD) is a health problem in postmenopausal women, and renal fibrosis is a common feature of CKD. In the renin-angiotensin system, oxidative stress and inflammation are involved in the pathogenesis of renal fibrosis. This study investigated the effect of the phytoestrogen daidzein on oxidative stress and inflammation and the mediation of the angiotensin AT1 and Mas receptors in a fibrotic model of kidney disease of ovariectomized (OVX) rats.

Unilateral ureteral obstruction (UUO) was performed to induce chronic renal inflammation and fibrosis in 84 OVX rats, which were divided into four main groups (each = 21) including sham + Vehicle (Veh.), UUO + Veh, UUO + estradiol (E2), and UUO + daidzein. Each main group composed of three subgroups (n = 7), which received saline, losartan (AT1R antagonist), or A779 (Mas receptor [MasR] antagonist) for 15 days after UUO or sham operation. Renal pathology, serum and kidney oxidants and antioxidants, malondialdehyde (MDA), nitric oxide metabolites (NOx), protein carbonyl (PC), and pro-inflammatory and anti- inflammatory cytokines were examined.

UUO increased renal glomerulosclerosis, inflammation, serum and kidney tissue MDA, NOx, and PC together with an increase in TNF-α, IL-1β, and IL-6 expression. Moreover, UUO decreased superoxide dismutase and glutathione peroxidase and catalase activity, total antioxidant capacity, and IL-10 level in the serum and kidney tissue. AT1R blockade reduced and MasR blockade worsened renal impairment. Daidzein and E2 alone and in co-treatment with losartan significantly ameliorated these effects.

Via interaction with AT1R and MasRs, daidzein improved glomerulosclerosis, oxidative stress, and inflammation in UUO-OVX rats. Daidzein may be a candidate for estrogen replacement therapy in postmenopausal or older women against postmenopausal kidney damage.

Despite the high incidence of AKI in patients with COVID-19, the characteristics and consequences of this condition have not been well studied.

This retrospective cohort study investigated the clinical characteristics, treatment methods, and outcome of COVID-19 patients aged 18 years and older who were hospitalized in Imam Hossein Hospital, Tehran, from February 20 th , 2020 to June 20 th , 2020.

Out of the total 367 patients with COVID-19, 104 (28%) patients were diagnosed with AKI at the time of admission or during hospitalization, 86 (23%) and 18 (5%) patients were diagnosed with the AKI on admission (early AKI) and after the first 24 h (late AKI), respectively. Concerning the AKI stages, 20 (19%) and 18 (17%) patients were in stages 2 and 3, and the cause of AKI in 52 (50%) patients was renal. Moreover, out of all patients with AKI, 25 (24%) and 29 (28%) patients had transient (Kidney function improvement within 48 h) and persistent AKI (kidney function improvement between 48 h to 7 days). Furthermore, 32 (31%) patients developed acute kidney damage (AKD) (no improvement in AKI after 7 days). The survival rate of AKI patients was lower in higher stages of AKI, and in cases that the reason for kidney dysfunction was renal or unknown. However, there was no difference in the mortality rate between the early and late AKI.

Since about one-third of the patients with AKI eventually develop AKD, it is of great importance to closely monitor all COVID-19 patients, especially the high-risk ones, for the appropriate diagnosis and treatment of AKI.

Despite developing strategies for antiviral treatment, cytomegalovirus (CMV) infection remains one of the most common challenges in kidney transplant recipients (KTRs). The evaluation of CMV viral load is still the most practical main clinical approach for CMV assessment and guides decision-making in recipient antiviral treatment. However, there is not a specific viral load cut off for initiating treatment yet. On the other hand, the cellular immune system and the innate immune response prove their roles in diagnosing CMV reinfection and monitoring the therapeutic regime to control CMV. Interactions among the components of cellular immunity encounter CMV reactivation provide a strong treatment management plan for clinical decisions about antiviral therapy against CMV. Natural killer (NK) cells, as essential effector cells, present potentially antiviral activity through distinct subpopulations. CCR7expressing NK cells were identified by high cytotoxicity and functionality among NK cell subsets. Here, we explored the correlation between CCR7+ expressing NK cells with viral load in CMV reactivated-kidney transplant recipients.

A cross-sectional study was conducted among ten CMV reactivated KTRs. The CMV DNA copy number was evaluated utilizing real-time PCR.NK cell phenotypic profiling was done using flow cytometry.

Increasing of CMV viral load in CMV reactivated KTRs had a negative correlation with CCR7+CD57+ CD56/CD16+ NK cell (P < .05 r = -0.7) after CMV reactivation. Significantly increased level of CCR7-CD57- CD56/CD16+ NK cell was associated with CMV viral load within CMV reactivated KTRs (P < .05, r = 0.68).

CCR7 expression is associated with CMV reactivation, which offers a new aspect of CMV-associated immunity within the NK cell compartment.

Crescentic IgA nephropathy (IgAN) with the positivity for antineutrophilic cytoplasmic antibody (ANCA) is a novel and uncommon entity. The optimal management of this condition is not well-defined. We report a 49-years-old woman with complaints of skin rash and swelling of lower limbs. She had hematuria, proteinuria and, progressive renal impairment with positive myeloperoxidase (MPO)-ANCA test. A renal biopsy revealed MPO-ANCA-associated crescentic IgAN. Induction therapy was intravenous methylprednisolone, cyclophosphamide and, therapeutic plasma exchange (TPE). An unexpected disease flare-up was observed during induction immunosuppressive therapy which regressed after long-term TPE. The patient experienced a full renal recovery after treatment with long-term TPE, cyclophosphamide, and corticosteroids.