JOURNAL OF RENAL INJURY PREVENTION
Year:2018 | Volume:7 | Issue:4|Papers Count:20

This study aims to review the literature pertaining to the renal effects of amphetamines (AMPs) including AMP and its analogues (ARDAs) such as methamphetamine (MET) and 3, 4-methylenedioxy-N-methylamphetamine (MDMA) and discuss the implications for these drugs users. The study was performed through searching in the relevant literature. Sufficient clinical and experimental evidence suggested that AMPs have adverse and potentially nonfatal and fatal effects on users’ kidneys. The acute and chronic renal complications due to illicit drugs such as AMPs have been investigated. A few renal effects in AMPs users have been demonstrated. However, isolated reports of adverse renal effects of AMPs including nephropathy due to rhabdomyolysis, necrotizing renal vasculopathy and malignant hypertension have been recorded. It can be suggested that renal damages after AMPs consumption should be considered in the emergency departments (EDs).

Introduction: Vitamin D deficiency can impact post-transplant outcomes due to its effect on graft function and rejection. The effect of pre-and post-transplant serum vitamin D levels was evaluated on graft function. Objectives: This study aims to determine the incidence of vitamin D deficiency and its effect on post kidney transplant allograft function in a North Indian cohort. Patients and Methods: We evaluated 57 patients on dialysis, going for transplantation. Estimated glomerular filtration rate (eGFR) was measured using modification of diet in renal disease (MDRD) formula at 2 weeks and 3, 6, 12 months interval after kidney transplantation. Results: Pre-and post-transplant (3 months) vitamin D levels were evaluated for vitamin D deficiency and graft function. Before transplant vitamin D levels were 25. 77 ± 13. 68 ng/mL, 40. 4% of these recipients had vitamin D deficiency (levels <20 ng/mL). After transplant, vitamin D levels at 3 months were 22. 08 ± 11. 15 ng/mL and 54. 4% of recipients had vitamin D deficiency. No patient was on vitamin D supplementation after transplantation. At 3 months post-transplant, recipients with vitamin D levels <20 ng/mL, had significantly lower eGFR and higher serum creatinine value as compared to the group with vitamin D levels >20ng/mL. Recipients were divided into 3 groups based on pre-and post-transplant vitamin D levels (<20, 20-30 and >30ng/mL). Pre-transplant vitamin D levels correlated with graft function at 14 days. On multiple regression analysis, 3-month post-transplant vitamin D levels correlated with 12 months eGFR. There was increased incidence of acute rejection episodes in vitamin D deficiency group. Conclusion: There is a high incidence of vitamin D deficiency and insufficiency in kidney transplant recipients. Low levels of post-transplant vitamin D levels at 3 months were associated with inferior allograft function (eGFR) at 1 year.

Introduction: Noise is defined as unpleasant and unwanted sound. Noise exposure has been associated with numerous health effects in human and experimental animals. Milk has very high nutritional value. It has been reported that this compound has protective properties against some chemical-induced toxicity. Objectives: The purpose of this study was to determine the protecting impact of buffalo’ s milk on noise produced nephrotoxicity in rats. Materials and Methods: Twenty adult Wistar male rats were divided into 4 groups in random order (n=5). First group was used as control, second group have received buffalo milk (1 mL/d) for 2 weeks, third group exposed to noise for about 100 decibels (dB) (2 weeks and 4 hours daily), fourth group received buffalo’ s milk (BM) (1 mL/d) 10 minutes before exposed to noise (100 dB for 4 hours daily) for 14 consecutive days. Around 24 hours later, all rats were killed because of overdose of sodium pentobarbital. Blood samples were collected and processed for evaluation of blood urea nitrogen (BUN) and creatinine (Cr). We removed kidney tissues, one part of the kidney tissue processed for determination of malondialdehyde (MDA) and glutathione (GSH) concentrations. Other parts were excised for histopathological observations. Results: The levels of BUN, Cr and MDA significantly increased, but the level of GSH markedly dropped in rats that exposed to noise in contrast to unexposed (control ) animals. Histopathological alterations were also noted in rat kidney exposed to noise. Administration of BM did not change biochemical parameters when compared to those in control values. However, giving BM prior exposure rats to noise markedly decreased the levels of BUN, Cr and MDA and increased the level of GSH when compared to those in non-pretreated noise exposed rats. BM also restored noise-induced morphological changes in rat kidney. Conclusion: This study demonstrated that exposed rats to noise-mediated kidney damage. BM showed a nephroprotective effect on noise caused oxidative stress and kidney dysfunction in rats.

Introduction: Nephrotoxicity is one of the most important side effects of cisplatin which has limited its use. Production of reactive oxygen species (ROS) and reactive nitrogen species (RNS) plays a significant role in the pathogenesis of this drug. Objectives: The aim of this study was to evaluate the antioxidant effect of zolpidem on the reduction of nephrotoxicity associated with cisplatin. Materials and Methods: In this study, 40 adult male rats were divided into 4 groups; 1) healthy group, 2) control group, 3, 4) cisplatin-induced nephrotoxicity + different doses of zolpidem. After a certain period of time, the urine, spinal cord and kidney samples of rats were collected. Then, urine levels of functional factors including urea, creatinine and albumin/creatinine ratio, antioxidant enzymes and malondialdehyde (MDA) levels were estimated. Consequently, histological studies were conducted with the collected samples. Results: Zolpidem reduced levels of urea, creatinine, albumin/creatinine ratio, and MDA. It also increased the amount of antioxidant enzymes of the kidney including superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPX), and moderated the tubular damage caused by the use of cisplatin. Conclusion: Zolpidem is able to improve the nephrotoxicity by reducing oxidative stress.

Introduction: One of the major healthcare measures in hospitals, is reducing the risk of infections. Since catheter-associated urinary tract infections (CA-UTIs) occur in 80% of cases, the prevention of these infections plays an important role in reducing infections related to the treatment care. Objectives: The present study aims to determine the effect of daily change of sterile urinary bag on the incidence of bacteriuria and CA-UTIs. Patients and Methods: This quasi-experimental study include all patients referred to the neurology, urology and surgery wards, as well as the ICU and CCU of Hajar and Kashani hospitals, Shahrekord, Iran. A total of 200 patients aged 18-75 years that required insertion of the urinary Foley catheter were divided into two groups: catheterization with the usual method (control group) and catheterization with daily change of sterile urinary bag (case group). In each of the two groups, immediately after insertion and during the removal of urethral catheter, the urine sample was collected using sterile method and was sent to the laboratory to conduct examinations for bacteriuria. The demographic information was prepared and collected using the researcher made questionnaire. Results: In this study, the average age of the patients was 49. 81 ± 15. 11. The rate of CA-UTI was more in the control group than the case group (29% as compared with 16%) (P = 0. 04). The average age of patients with infection due to urethral catheterization was found to be higher (55. 4 ± 14. 52 versus 48. 4 ± 14. 92) (P < 0. 001). Conclusion: While a preference for closed drainage system existed, however in the present study, it was found that with daily change of sterile urinary bag even with opening of system, the rate of CA-UTI was reduced.

Introduction: Prevalence of diabetes and its complications will be considerably increased in the future. This study focused on the correlation of some laboratory parameters with prevalence and severity of diabetic nephropathy which is the main cause of chronic renal failure (CRF) in our country. Objectives: Regarding the importance of diabetic nephropathy and lack of studies on the effect of serum C-reactive protein (CRP) and uric acid on albuminuria and its severity, the current study was designed. Methods: Through an analytic cross-sectional design, 200 type 2 diabetes mellitus (T2DM) cases were recruited between 2014 and 2015. Blood samples were drawn after 12 hours of starving to measure parameters including serum levels of CRP, triglyceride (TG) and highdensity lipoprotein cholesterol (HDL-C), cholesterol, Low-density lipoprotein (LDL-C), fasting blood sugar (FBS), and Hb-A1C. Albuminuria was assessed by collecting participants’ 24 hours urine. Results: Macro-albuminuria correlated with high serum uric acid (SUA) (odds ratio [OR]= 1. 3) and high serum CRP (OR = 1. 2) among diabetic patients. Both markers represented significant correlation with albuminuria. Logistic regression test confirmed the mentioned correlation when confounding factors were eliminated. Conclusion: It seems that uric acid and CRP levels in serum are the most reliable parameters studied by the current study to predict life-threatening diabetic consequences like cardiovascular and chronic kidney disease in patients with type II diabetes mellitus.

Introduction: Pruritus involves many hemodialysis (HD) patients and has a close association with sleep quality and health-related quality of life. Objectives: The aim of this study was to determine predictors of pruritus and insomnia, the effect of pruritus on the severity of sleeping difficulties, and also their impacts on the health quality, hospitalization and mortality in a multicenter cohort of HD patients. Patients and Methods: Pruritus and sleep problems data were obtained in 416 HD patients from nine dialysis facilities in September 2012. SF36 quality of life and a comprehensive questionnaire was provided for the patients. Patients were followed for a median of 28 months. Unadjusted and adjusted odds ratio (AOR) of having pruritus/sleep disturbances for different variables and relative risk of death was calculated. Results. Moderate to extreme pruritus and insomnia were respectively identified in 38% and 49% of HD patients. Independent predictors of having severe to extreme pruritus were hyperphosphatemia (mg/dL) (AOR: 1. 34; 95% CI: 1. 06-1. 70), anemia (g/dL) (AOR: 1. 27; 95% CI: 1. 04-1. 56), and older age (year) (AOR: 1. 02; 95% CI: 1. 00-1. 04). These predictors for severe to extreme insomnia were dialysis vintage (year) (AOR: 1. 14; 95% CI: 1. 04-1. 26), worse bodily pain (AOR: 1. 01; 95% CI: 1. 00-1. 03), poor mental health (AOR: 1. 02; 95% CI: 1. 01-1. 04), and severe to extreme pruritus (AOR: 8. 80; 95% CI: 3. 24-23. 91). SF36 quality of life was becoming significantly lower with increasing the degree of pruritus/insomnia. Likewise, hospitalization was more common in these patients. During the follow up 123 (29. 6%) patients passed away. The full-adjusted relative risk of death for extreme insomnia was 1. 72 (95% CI: 1. 00-3. 03; P = 0. 05). Conclusion: Moderate to extreme pruritus/insomnia are quite common in HD patients and significantly affect quality of life. Pruritus is a great predictor of insomnia. Extreme insomnia is an independent predictor of death.

Introduction: Acute kidney injury (AKI) is known to be one of the major complications of critically ill children and accounts for a 30%-90% mortality of such patients. Early identification of such patients can significantly influence their mortality and morbidity. Objectives: Serum creatinine levels are not a good marker of early renal dysfunction. Numerous novel biomarkers have been proposed for the detection of AKI. In this study we sought to evaluate the ability of serum creatinine and serum cystatin C levels in the early detection of AKI. Patients and Methods: In this prospective study, serum cystatin C and creatinine levels were serially measured in a group of critically ill children older than 6 months, admitted to the intensive care unit of a tertiary care children hospital. Results: Around 54 patients were evaluated in this study. About 13 of them developed AKI. Serum cystatin C levels significantly changed over time in these patients. Changes in cystatin C levels were more prominent in patients with AKI in comparison with patients with normal renal function or those at risk for kidney injury. Rate of serum cystatin C elevation was more rapid than serum creatinine elevation in patients with AKI (p<0. 05) and thus serum cystatin C levels can detect kidney injury earlier. Conclusion: Serum cystatin C is applicable as a good biomarker of renal function in early stages of kidney injury. Hence, we can use serum cystatin C for the early detection of AKI in patients more accurately.

Introduction: End-stage renal disease (ESRD( is an increasing problem in the world. Kidney transplant is considered as preferred therapeutic method for ESRD. Options for organ transplantation include living related donor (LRD), living unrelated donor (LURD) and cadaveric donor. Objectives: This study was aimed to evaluate the effect of type of donor on graft and survival rate of patients. Patients and Methods: This study was cross-sectional, which used Meier method to calculate the patient survival rate. Additionally log-rank test was applied to compare the survival curves; analysis of variance (ANOVA) was applied to compare continuous variables and χ 2 test was used to compare the data. Data were analyzed using SPSS version 19 and P values less than 0. 05 was considered significant. Results: The mean duration of follow-up in LRD, LURD and cadaveric recipients were 60. 37± 34. 2, 79. 17± 33 and 61. 17± 34 months respectively. Five-year survival, in LRD was 100 months, in LURD recipients was 87± 0. 01 months, and in cadaveric recipients was 91± 0. 03 months. The mean survival of graft in LRD, LURD and cadaveric recipients were 115. 5± 3. 1, 103. 27± 1. 2 and 102. 15± 4. 5 months, respectively. Log-rank test showed a significant difference between graft survival in recipients (P = 0. 038). Conclusion: The results showed that LRD is one of the factors affecting graft survival. Hence, graft survival rate showed high length among patients who their graft was from LRD compared to LURD and cadaveric.

Introduction: The goal of any physician who cares about dialysis patients is to increase their quality of life. Many studies have shown that residual renal function (RRF) in dialysis patients, especially those undergoing peritoneal dialysis (PD), is an important prognostic factor for mortality. Objectives: In the present study, we aimed to investigate the effect of N-acetylcysteine (NAC) as an antioxidant on increasing RRF in chronic hemodialysis (HD) patients. Patients and Methods: Ninety-eight chronic HD patients who have urinary output greater than 100 cc in 24 hours participated in this study and were divided into two groups of treatment and control (49 patients each). Subsequently, the oral NAC treatment group received 600 mg tablets twice a day before meals. The control group received placebo tablets again twice a day before meals. The duration of the study was 4 weeks. Results: The RRF significantly improved in the treatment group during the study period, but no significant changes were observed in the control group. Residual glomerular filtration rate (GFR) rose from 1. 7 ± 0. 73 to 2. 7 ± 1. 1 mL/min/1. 73 m2 (P < 0. 0001) in the treatment group, while in the control group, there was a slight increase from 2. 1 ± 0. 94 to 2. 2 ± 1. 19 mL/min/1. 73 m2 (P = 0. 26). Additionally, the average daily volume of urine in the treatment group increased from 594 ± 436 to 953 ± 540 mL/24 h (P < 0. 0001) in the treatment group and from 809 ± 573 to 771 ± 552 mL/24 h (P = 0. 11) in the control group. Finally, the calculation of residual renal Kt/V per week showed an increase from 0. 21 ± 0. 06 to 0. 31 ± 0. 08 (P < 0. 0001) in the treatment group and a decrease from 0. 23 ± 0. 08 to 0. 22 ± 0. 08 (P = 0. 22) in the control group. Conclusion: Our study showed that a 4-week NAC treatment improves RRF in chronic HD patients.

Introduction: Decreased vitamin D levels may have a role in the development of metabolic syndrome due to its effect on the metabolic syndrome components or because of insulin resistance. Objectives: The aim of this study was to investigate the prevalence of vitamin D deficiency in obese individuals and to determine the relationship between deficiency of vitamin D with metabolic syndrome in obese people with metabolic syndrome and healthy individuals. Patients and Methods: In this descriptive-analytical study, samples were selected among obese individuals admitted to Hajar and Kashani hospitals in Shahrekord. Metabolic indices of the samples were measured and recorded along with information such as demographic characteristics. According to the indices, the subjects (n= 192) were divided into two equal groups of healthy obese and obese people with metabolic syndrome. Vitamin D levels were measured in both groups followed by determination of relationships between the vitamin D levels with metabolic syndrome and its indices. Results: The mean ages of the patients and healthy groups were 50. 09± 1. 95 years and 52. 57± 2. 05 years, respectively. The average serum vitamin D levels in the two groups showed a significant difference with significantly lower vitamin D levels in the metabolic syndrome group than those in the obese subjects (P < 0. 001). The relationship between each of the metabolic syndrome indices at different levels of vitamin D showed that levels of triglyceride (TG) and fasting blood sugar (FBS) decreased with increasing serum vitamin D. However, the level of vitamin D was not significantly related to the waist size and body mass index (BMI) (P > 0. 05). Conclusion: The results of this study indicated that vitamin D determination can be used for the prognosis and early detection of people at risk for metabolic syndrome.

Introduction: Asymptomatic Staphylococcus aureus carriers have become a great concern because of being at risk of subsequent S. aureus infections. The role of nasal S. aureus carriages as an endogenous source for staphylococcal infections especially methicillin resistant S. aureus (MRSA) infections has been known that seems to be contributed to morbidity, mortality, and also the cost of end-stage renal disease management. Besides, many recent studies have demonstrated that extranasal sites may be important unrecognized reservoirs for resistant S. aureus. Objectives: The purpose of the present research was to identify the frequency and factors associated with extra-nasal S. aureus colonization among maintenance hemodialysis patients. Patients and Methods: A total of 179 hemodialysis patients were enrolled in this study. Swab cultures were obtained from anterior nares, posterior pharynx, and the inguinal area. Culture plates were analyzed for the presence of methicillin-resistant or methicillin-susceptible S. aureus using standard microbiological techniques for S. aureus and MRSA. Results: 113 out of 179 patients (63%) were men and 66 (37%) were women with the mean age of 59. 8± 13. 6 years. 36 out of 179 patients (20%) were colonized with S. aureus which 5 patients (2. 7%) were colonized with MRSA. Prevalence of extra-nasal S. aureus colonization was 12% ( 22/179 patients), the prevalence of nasal S. aureus colonization was 10% (18/179 patients) and 2. 7% of patients (5/179 patients) were colonized with S. aureus in more than one body site. Around 3 out of 5 MRSA colonized patients (60%) were extra-nasal carriers. There was a significant association between type of venous access for dialysis with the extra-nasal colonization (P = 0. 03) and also an association between underlying disease of diabetes mellitus type 2 with the extra-nasal colonization (P = 0. 01). Conclusion: This study has emphasized the importance of extra-nasal evaluation along with nasal site sampling as an endogenous risk factor for staphylococcal infections among hemodialysis patients.

Introduction: Inflammation plays an important role in the pathogenesis of cardiovascular diseases in patients receiving hemodialysis. Objectives: To compare serum levels of quantitative as high-sensitive C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), and cancer antigen 125 (CA-125) among three groups including hemodialysis with heart failure (HF), hemodialysis without HF and healthy controls. Patients and Methods: Seventy patients with chronic kidney disease (CKD) receiving hemodialysis were included. Thirty-five healthy subjects were in the control group. Inflammatory markers were measured. All subjects underwent 2D transthoracic echocardiography. HF was defined as LVEF (left ventricular ejection fraction) <50%. Results: ESR and hs-CRP levels, but not CA-125, were significantly higher in hemodialysis group versus control group. Median (IQR) ESR was significantly higher in hemodialysis group with systolic HF ([16. 50 [17]) and without systolic HF (15. 50 [21]) compared to control group (8 [7]); P < 0. 001. Likewise, median (IQR) hs-CRP was higher in hemodialysis with HF (9 [3]) and without HF (9 [5]) than in control group (4[2]); P < 0. 001. The Mann-Whitney U tests did not show any statistically significant difference within hemodialysis group between those with and without HF regarding ESR (P = 0. 81) or hs-CRP (P = 0. 76). However, median (IQR) CA-125 value was significantly higher in hemodialysis with systolic HF group (23. 20 [25. 04]) compared to hemodialysis without systolic HF (11. 40 [8. 91]); P = 0. 003. Conclusion: ESR and hs-CRP levels are increased among ESRD patients on hemodialysis regardless of the presentence of HF. However, CA-125 was the only marker which showed a significant increase in the presence of HF. CA-125 needs further studies to determine its role in follow-up and prognosis of CKD patients with systolic HF.

Introduction: Urinary tract infection (UTI) is one of the most common infection following kidney transplant surgery. Objectives: This study was aimed to evaluate the effect of UTI after transplant on patients and graft survival rate. Patients and Methods: This study was cross-sectional and the data collected retrospectively. Kaplan-Meier method was used to calculate the survival rate of patients and log-rank test was applied to compare the survival curves. Cox regression model was applied for modeling the factors affecting survival rate. The data were analyzed using SPSS version 19. The level of significance considered less than 0. 05. Results: The mean duration of follow-up in infected and non-infected patients following kidney transplantation surgery were 53. 78± 24. 5 months and 67± 40. 8 months, respectively. Ten-year survival rate in infected by UTI and in non-infected by UTI were 78± 0. 03% and 89± 0. 02%, respectively. Also, 10-year graft survival rate in infected patients and in noninfected patients were 71± 0. 03% and 88± 0. 02%, respectively. Log-rank test showed a significant difference between infected and non-infected patients regarding graft survival rate (P < 0. 001). Conclusion: The results showed that the survival rate of patients was different in infected and non-infected patients. This finding indicated the importance of follow-up in patients with infection following kidney transplant surgery.

Introduction: Serum level of high sensitivity C-reactive protein (hs-CRP), as an inflammatory marker, can play a role in development of metabolic syndrome in obese individuals. Objectives: This study aimed to determine serum concentration of hs-CRP in obese patients with metabolic syndrome and determine the association of this factor with factors involved in the progression of metabolic syndrome. Patients and Methods: In this study, samples were selected by convenient method from obese patients, admitted to Kashani and Hajar hospitals (Shahrekord, Iran). First, based on NCEP-ATPIII-defined metabolic syndrome, parameters of metabolic syndrome and serum levels of vitamin D were measured and a questionnaire containing demographics was completed for each participant. Accordingly, the samples (n=192) were divided into two identical groups; obese individuals without metabolic syndrome (controls) and obese individuals with metabolic syndrome (case group). Hs-CRP levels were measured in both groups. Results: Serum level of hs-CRP in the case group was 17. 58± 1. 40 μ g/mL and in the control group was 9. 04± 1. 26 μ g/mL, which was significantly higher in the case group than the control group (P < 0. 001). Serum concentration of hs-CRP in case and control subjects had a negative significant correlation with vitamin D (P <0. 001), however, serum level of hs-CRP had no significant association with high density lipoprotein cholesterol (HDL-C), triglyceride (TG), fasting blood sugar (FBS), abdominal circumference, body mass index (BMI), and height (P > 0. 05). Conclusion: Hs-CRP can be used for prognosis and early detection of patients at risk of metabolic syndrome.

Introduction: Poor oral health and periodontitis is an important problem in chronic kidney disease (CKD) patients on hemodialysis (HD) awaiting kidney transplantation. This could contribute to increased morbidity and mortality as a result of infections and consequences of inflammation. Objectives: To study the oral health status and assess its impact in inducing inflammation in CKD patients on HD. Patients and Methods: Fifty CKD patients on HD (group I) were compared with 50 healthy controls (group-II) in a prospective cohort study. Oral health assessment was done with the WHO oral health assessment form with a mouth mirror and a community periodontal index (CPI) probe by a trained dentist. The demographic clinical data of oral health and periodontitis was collected in dialysis patients and healthy controls. CRP levels were assayed as markers of inflammation. Results: Data shows that patients on dialysis have evidence of increased inflammation as indicated by raised CRP values. Our study shows the poor oral and mouth hygiene and periodontitis and inflammation was much more in dialysis patients as compared to control group (P < 0. 05). Amongst dialysis patients with higher inflammation (CRP values), there was poorer oral health and more periodontitis (P < 0. 05). This indicates that higher inflammation could result from poor dental hygiene and periodontitis. Conclusion: Poor oral and mouth hygiene was associated with inflammation as indicated by high CRP values in CKD patients on dialysis with poor dental hygiene. Periodontitis was significantly associated with development of inflammation.

To date, several studies have been done on efficacy and safety of drugs in children with refractory nephrotic syndrome (NS). Rituximab (RTX) might be a hopeful treatment for this syndrome. However, the long-term effects and cost-effectiveness of RTX treatment were not fully assessed. This study aims to do a systematic review about the efficacy and safety of RTX in children with difficult-to-treat NS. For this research, an electronic literature search was conducted to identify appropriate investigations. The search term was (“ nephrotic syndrome” or “ minimal change disease” or “ focal segmental glomerulosclerosis” or membranous) and (‘ ‘ rituximab’ ’ or ‘ ‘ CD20’ ’ ). We included all randomized trials and observational studies about using RTX in children with difficult-to-treat NS. Two independent reviewers extracted data from the papers according to the selection criteria. Eligible studies were included in this systematic review. The literature search and reference mining yielded 919 potential relevant papers. We removed 340 articles because of duplication. We also excluded 513 papers after reviewing the titles and abstracts. Finally, 17 studies were included in the systematic review. Efficacy of RTX in children with NS in most of the studies was assessed with relapse-free survival or complete remission rates. Acknowledging the limitations of the study due to the size and nature of the studies included, our systematic review shows that RTX was effective in the treatment of refractory NS in children, and it could reduce the use of steroid and immunosuppressants. However, further large randomized trials are suggested.

Acute renal failure (ARF) is a major medical problem during pregnancy with maternal and fetal outcomes. While the trend of pregnancy-related ARF is on a decline due to the advances in obstetrics care and the legality of abortion among developed countries, this situation remains one of the serious health problems in the developing nations. This review aims to evaluate the current studies with regards to pregnancy related ARF pathophysiology, risk factors and treatment. PubMed, Embase, Scopus and directory of open access journals (DOAJ) databases were searched to obtain the information. Most of the studies in this review were conducted in observational, both prospective and retrospective studies. Results demonstrated a variety of major pregnancy-related ARF causes including obstetric hemorrhage, hypertensive disorders in pregnancy, sepsis, thrombotic microangiopathy and acute fatty liver in pregnancy. Aside from awareness of the pathogenesis of pregnancy-related ARF and its risk factors, understanding the physiological renal adaptation during pregnancy is essential for early detection, diagnosis, and proper management to prevent the pregnancy related complications.

Leontiasis ossea is a rare presentation of renal osteodystrophy with few reports in literature. It causes severe skeletal deformity in the cranial bones. This study presents a report on a patient with advanced hyperparathyroidism with skeletal changes compatible with leontiasis ossea. The patient was a 34-year-old man with end-stage renal disease, uncontrolled hypertension, and dyspnea who was referred to our hospital. Physical examinations revealed: toggled speech (nasal speech), mouth breathing and facial change, saddle nose, nares widening, increased interdental space and mandibular enlargement. His serum intact parathyroid hormone (iPTH) level was 3199 pg/mL, Paranasal sinuses CT scan showed a significant expansion of the mandibular, maxillary and skull bones. Parathyroid sonography reported two severe hypertrophied parathyroid glands. The patient underwent total parathyroidectomy as a result of symptomatic bone involvement.

Dear Editor, With great interest, we recently read the published article by Shayanpour and colleagues entitled “ Evaluating the effect of N-acetylcysteine on residual renal function in chronic hemodialysis patients treated with low-flux dialysis membrane; a randomized clinical trial” in your esteemed journal (1). ...