Nephro-Urology Monthly
Year:2022 | Volume:14 | Issue:2|Papers Count:12

Background: Renal stone disease is a very common disease, and its lifetime prevalence is 1-15%, with a gradual rise in incidence and disease prevalence. There are signifi cant fi nancial implications of its management. Nowadays, for big (typically > 2 cm) renal and upper ureteric stones, PCNL is widely regarded as the fi rst-line treatment. Because most of the intrarenal collecting systems can be accessed by superior calyceal puncture in PCNL, good stone clearance can be achieved. The “ Guy’ s Stone Score” is a useful technique for categorizing the complexity of PCNL. Objectives: This study aimed to evaluate the role of Guys Stone Score based on KUB and intravenous urography to predict the success rate, grading, and complexity of PCNL, which are performed via the upper pole access. Methods: The present prospective, non-randomized observational study was undertaken in the Department of Urology and Renal transplantation, SCBMCH, Cuttack, from 1st November 2017 to 31st October 2019. A total of 104 patients were enrolled in the study in whom PCNL was performed through superior calyceal puncture, based on preoperative intravenous pyelogram. The Guy’ s Stone Score was calculated, and the complexity of the procedure was graded using radiological studies, then the outcome was determined accordingly. Results: In this study, 59. 6% of the patients had immediate success among them 29. 0% had grade 3, and 6. 5% had grade 4 GSS. Moreover, 38. 4% of the patients had clinically signifi cant residual fragments among them, 75. 0% had grade 4, and 20. 0% had grade 3 GSS. 23% of the patients underwent REDO-PCNL and 11. 5% of the patients underwent accesory/ancillary procedure of ESWL. Conclusions: The present study shows that an intravenous pyelogram-based Guy’ s Stone Score (GSS) is an easy-to-use tool in predicting the early success rate and potential diffi culties and complications in PCNL performed through superior calyceal puncture.

Background: The Coronavirus has caused an epidemic aff ecting the whole world for the last two years and has been spreading steadily. The hemodialysis patients are at high risk because of their lowered immunity status. The dialysis staff is also at higher risk of contracting COVID-19 as these patients come for twice/thrice weekly treatment sessions. Objectives: This study was done to study the hardships and problems affl icting the dialysis staff during the infections caused by COVID-19 in a rural hemodialysis unit. Methods: This study setting was the hemodialysis unit located in a rural hospital in Pondicherry, India. Free listing and pile sorting were done to study the structure and salient problems as felt in the cognitive domain by the dialysis team. Smith’ s S value was calculated for a free listing. Multidimensional scaling and cluster analysis were conducted to do pile sorting of data. Data were analyzed using Anthropac 4. 983/X. Group interviews were carried out to get in-depth information and validate the fi ndings obtained from the free list and pile sorting exercise. Results: Twelve salient items were obtained from the free list. Three broad domains emerged: the absence of personal safety, shortage of personal safety equipment, and presence of logistical and operational problems. Surprisingly, RT-PCR testing was not perceived to be of importance for them. Conclusions: Accepting the true feelings, fears, and needs of the dialysis staff , helping to tackle the impediments to personal safety, and the lack of personal safety equipment in a dialysis unit during COVID-19 outbreak are vital in ensuring personal safety and improving working dynamics.

Context: The SARS-CoV-2 virus causes dysfunction of vital organs in the body. Concerns about the destructive eff ect of SARS-CoV-2 on human reproductive tissues and fertility have increased. Evaluation of the possible mechanisms by which SARS-CoV-2 causes infertility is essential for eff ective prevention and treatment. This review aims to assess the studies that have been conducted on SARS-CoV-2 impacts on the human reproductive system. Evidence Acquisition: This review study investigated articles indexed in PubMed, Science-Direct, Scopus, and google scholar databases from 2019 to 2021. The Keywords SARS-CoV-2, COVID-19, human reproductive system, testis, and ovary were searched in the mentioned databases. Results: The present study assessed the expression of SARS-CoV-2-specifi c receptors, the presence of the virus in the human reproductive system, and the mechanisms by which this virus can aff ect human fertility. Conclusions: SARS-CoV-2, like other viruses, may indirectly infl uence the male reproductive system through cytokine storms, infl ammation-causing oxidative stress, and its possible complications. The direct eff ects of SARS-CoV-2 on the male reproductive system are also reported. The testis may be a potential target for the SARS-CoV-2 virus. The impact of the SARS-CoV-2 virus on women’ s reproductive performance is unknown and requires further investigation.

Background: Chronic kidney disease (CKD) is an increasingly common disease worldwide and has become a global health problem, especially in Vietnam. Cystatin C is a marker for the detection, classifi cation, and prognosis of CKD. Cystatin C is fi ltered entirely through the glomerular membrane, reabsorbed, and metabolized completely in the renal tubules. In case of damage to the kidneys, glomerular fi ltration rate declines, and some substances increase in the blood, such as cystatin C. The concentration of cystatin C changes with damage to the renal system. Objectives: This study aimed to estimate the concentration of cystatin C and its variation in the diff erent stages of CKD. Methods: A descriptive, cross-sectional study was conducted on 40 healthy individuals and 137 patients with CKD grade III, IV, and V in 103 Hospital. The concentration of cystatin C was estimated in all subjects. Results: Cystatin C plasma levels were signifi cantly higher in the CKD group (9. 17  3. 75 mg/L) than in the control group (0. 82  0. 12 mg/L). Cystatin C plasma levels increased linearly with the serious kidney failure as the stage of CKD. Conclusions: Cystatin C is an eff ective marker for estimating kidney damage in CKD.

Introduction: Ureteral injuries are considered as rare complications of posterior lumbar interbody fusion (PLIF). There are few reports in the literature on ureteral injuries following PLIF. The present report presented a case of right ureteral injury by passing fi ve years from PLIF. Case Presentation: The patient was a 51-year-old woman who has been referred to urologist with the complaints of fl ank pain, fever, anorexia, vomiting, and nausea, and a history of PLIF fi ve years ago. After radiological examinations, ureteral obstruction was diagnosed and then open surgery was performed. Severe adhesions and fi brosis were observed in the retroperitoneal next to the lumbar vertebra implant. Thereafter, the ureteral stenosis was removed, the ureter was anastomosed end-to-end, and Double J was placed. The anastomosis site was covered with a fl ap of perinephric adipose tissue in order to prevent re-fi brosis. Conclusions: This report aimed to inform surgeons of a rare complication, a ureteral injury that has happened fi ve years after PLIF, along with its non-specifi c signs.

Background: Following the global outbreak of severe acute respiratory syndrome coronavirus 2 in diff erent communities, hemodialysis patients have not been spared by this viral infection. Objectives: This study evaluated the clinical symptoms laboratory and imaging fi ndings in patients undergoing hemodialysis and compared these characteristics with the control group. Methods: The study was performed on 72 patients with positive COVID-19 polymerase chain reaction test, of whom 36 cases had endstage renal disease undergoing hemodialysis and the remaining had no history of kidney diseases. After matching the two groups in terms of age, sex, and other underlying diseases, the clinical, laboratory, and chest computed tomography (CT) scan fi ndings were compared between the case and control groups. Results: The mean age of dialysis patients was 42. 52  12. 10 years and 48. 58  17. 35 years in the control group. The study results revealed that hemodialysis patients had less fever, cough, and shortness of breath than the control group (P-value < 0. 05). Hemoglobin, lymphocyte, and platelet counts were signifi cantly lower in hemodialysis patients in comparison to the control group (P-value < 0. 05). C-reactive protein was signifi cantly higher in patients undergoing hemodialysis (P-value = 0. 01), and ground-glass opacifi cation was observed more in patients undergoing hemodialysis compared to controls, but this diff erence was not statically signifi cant (P = 0. 07). Conclusions: Hemodialysis patients had fewer initial clinical symptoms but more abnormalities in laboratory fi ndings and ground-glass opacities on chest CT scans and a higher mortality rate.

Background: End-stage kidney disease (ESKD) patients undergoing hemodialysis suff er from multiple comorbidities, including cardiovascular disorders. Calcium phosphate product is one of the stand-alone cardiovascular risk markers. The relationship between calcium phosphate product-based cardiovascular risk and HRQOL needs to be further studied. Methods: This project was a cross-sectional survey using the Kidney Disease Quality of Life (KDQOL-36) of patient health-related quality of life (HRQOL). Calcium phosphate product was calculated from the information in the medical records. The study was conducted at the hemodialysis ward of the hospital affi liated with the Gulf Medical University. Spearman’ s correlation coeffi cient (rs) was used to explore an association (correlation) between HRQOL domains and categorized calcium phosphate products. In this study, the signifi cance level was set at P = 0. 05, and SPSS software version 26 was used to analyze the data. Results: The mean score (58%) of the Short Form (SF)-12 Physical composite was lower than the mean score of mental composite (70%). Among kidney-specifi c domains, the highest HRQOL score was associated with the symptom/problem list (71%), followed by eff ects on kidney disease (63%) and the burden of kidney disease (40%), respectively. There was a non-strong negative correlation between the ‘ burden of kidney disease’ and corrected calcium phosphate product (rs-0. 439, P-value 0. 032) and between ‘ symptom/ problem list’ and corrected calcium phosphate product (rs-0. 431, P-value 0. 035), and the other KDQOL domains revealed insignifi cant relationship with calcium phosphate product. Conclusions: ESKD aff ects HRQOL in patients undergoing maintenance hemodialysis. Calcium phosphate product also needs to be decreased by < 55 mg/dL in the concerned patients. Calcium phosphate product and HRQOL were not correlated in this group of patients. The HRQOL measures need to be revised to detect cardiovascular risk.

Background: Non-pharmacological care interventions like aromatherapy can be cost-eff ective and effi cient ways to reduce anxiety and adverse results before surgery. Objectives: In this study, the effi cacy of aromatherapy on pre-operative anxiety in patients undergoing Percutaneous Nephrolithotomy (PCNL) referring to Peymaniyeh Hospital in Jahrom-Iran was the main goal. Methods: This controlled-randomized trial was conducted on 38 patients that were randomly assigned to two groups: Control and Aromatherapy (Rosa damascena). The anxiety levels were recorded for all two groups the night before the surgery. On the day of surgery and after re-communication, patients were approached in a pre-operative holding area, and the intervention was performed. Data were collected over 11 months from June 2015 to May 2016. Results: The statistically signifi cant diff erence after the intervention between the control and intervention groups indicated that Aromatherapy with Rosa damascene reduced the patient’ s anxiety. Conclusions: This survey prepares evidence for the use of Damask rose as an anti-anxiety intervention. Using Damask rose as a nursing intervention helps nurses provide individualized care and helps patients control their anxiety.

Considering that there are diff erent reports about the eff ects of angiotensin II type-I receptor blockers (ARB) and angiotensinconverting enzyme inhibitors (ACEI) on the outcomes of the patients with COVID-19, we aimed to conduct this retrospective study on 138 hypertensive patients (81 ACEI/ARB users) to assess the patients’ outcomes by comparing ACEI/ARB and non-ACEI/ARB users. Multivariate adjusted cox regression model, by considering the eff ect of other variables, demonstrated that increased age (HR = 1. 04, 95% CI = 1. 01-1. 07, P =0. 003) and non-ACEI/ARB users (HR = 2. 12 95% CI = 1. 12-4. 13, P = 0. 021) were associated with increased risk of in-hospital mortality in about one week follow-up. In conclusion, we found that in-hospital mortality was lower in ACEI/ARB users, showing the positive eff ect of these treatments on patients’ outcomes.

Background: Gastroenteritis, as a rare and heterogeneous condition, is characterized by patchy or diff use infi ltration of gastrointestinal tissue. Induced azotemia in humans following gastroenteritis has been evaluated in some studies. Objectives: The aim of this study was to evaluate the eff ect of montelukast on induced azotemia in humans following gastroenteritis. Methods: This study examined children with gastroenteritis with moderate dehydration and more than 3 years of age. The cases had a glomerular fi ltration rate (GFR) of less than 90 and were evaluated in 2 groups of control (n = 20) and intervention (n = 20). Montelukast (5-mg tablets) was given to patients in the intervention group for 5 days. Normal saline at a rate of 20 cc/kg was given to both groups within 20 minutes until clinical symptoms improved. Finally, the improvement of renal function was evaluated and compared between the 2 groups using SPSS. Results: Out of 40 evaluated patients, the mean age of the control and intervention groups was 5. 52 and 5. 15 years, respectively. Also, 13 cases (65. 0%) in the control group and 9 cases (45. 0%) in the control group were males. The mean creatinine (Cr) was signifi cantly reduced after treatment in the intervention group (P = 0. 001). Also, the mean GFR after treatment was signifi cantly higher in the intervention group (P = 0. 001), and GFR improvement duration was signifi cantly lower in the intervention group (P = 0. 002). Conclusions: Montelukast as an add-on drug was eff ective in reducing the time of GFR enhancement; thus, we can consider it as an add-on drug in azotemia.

Background: To investigate the clinical signifi cance of the intravesical prostatic protrusion (IPP) index in benign prostatic hyperplasia (BPH) patients to clarify its diagnostic value in predicting the clinical and structural abnormalities of the prostate. Methods: In this descriptive and analytical cross-sectional study, every man older than 50 years with lower urinary tract symptoms (LUTS), predominantly voiding or obstructive, suggestive of BPH were included. The patients were evaluated to determine the following indices: International Prostate Symptom Score (IPSS) index, quality of life (QoL), prostate volume (PV) and postvoid residual urine (PVR), serum PSA level, and the maximum urinary fl ow rate (Qmax) obtained by urofl owmetry. Subsequently, the assessment of the IPP index was conducted by transabdominal ultrasonography. The categorization of the IPP index was done into 3 grades: grade one (below 5 mm), grade two (between 5 and 10 mm), and grade three (greater than 10 mm). Results: A signifi cant direct correlation between the IPP and IPSS, QoL, PV, PVR, and serum PSA, as well as inversely with the Qmax, was detected before and after medical treatment. Also, the need for surgical intervention increased signifi cantly with the IPP index. Conclusions: The IPP can be used to evaluate and predict the severity of symptoms and outcomes in patients with clinical BPH.

Background: Iron management is essential for anemia treatment in chronic kidney disease. The reticulocyte hemoglobin equivalent (RET-He) is a reticulocyte parameter that refl ects hemoglobin synthesis of newly formed erythrocytes in the bone marrow in real-time. Objectives: This study aims to evaluate the role of reticulocyte hemoglobin equivalent (RET-He) in predicting iron defi ciency in chronic kidney disease (CKD) patients. Methods: Following a descriptive cross-sectional observational design, this study was conducted on 131 adult patients with CKD stages 3-5. Laboratory indices, including complete blood count, some biochemical indices, iron status, and reticulocyte indices (including RET-He), were measured. Iron defi ciency (ID) was defi ned as TSAT < 20%, where serum ferritin level > 100 ng/mL was defi ned as functional ID, while serum ferritin level <100 ng/mL was defi ned as absolute ID. Results: Nearly 42% of patients had ID. The mean concentration of RET-He in CKD patients with ID was signifi cantly lower than that of patients without ID (P < 0. 001). Based on the Receiver Operating Characteristic (ROC) curve model, RET-He had a good predictive value for ID in CKD patients (AUC = 0. 762; P < 0. 001; cut-off value: 28. 15 g/L, the sensitivity of 45. 5%, and the specifi city of 100%). Serum iron, RET-He, serum albumin, and mean corpuscular volume (MCV) were independent risk factors to predict ID in CKD patients. Conclusions: This study demonstrated that RET-He is an appropriate index to predict ID in CKD patients.