Nephro-Urology Monthly
Year:2022 | Volume:14 | Issue:1|Papers Count:12

Background: End-stage renal disease (ESRD) can be fatal without hemodialysis, peritoneal dialysis, or kidney transplantation. Hemodialysis and peritoneal dialysis participants confront many adverse eff ects due to both the disease course and the treatment program. Objectives: This study was done to analyze hemodialysis and peritoneal dialysis patients’ problems. Methods: A qualitative exploratory study was used, and a purposeful sample of 55 hemodialysis and 47 peritoneal dialysis patients were interviewed. The data were collected through interviews. Initially, 12 open-ended questions were developed and used to stimulate discussions in interview sessions. Directed content analysis was used for the analysis of the transcribed data. After giving a code to each line or incidence, codes were then compared for similarity and diff erences, merged, and categorized. Results: Themes of fatigue, diminished ability, sleeplessness, wasting time, body impairments, travel, and free-time activities limitations, low blood pressure, displeasure and gratifi cation with hemodialysis if peritoneal dialysis patients compliant of peritoneal catheter problems, peritoneal dialysis diffi culties and limitations, and gratifi cation with peritoneal dialysis emerged. Conclusions: Hemodialysis problems and patients’ dependency on the hemodialysis machine and ward are at a high level, and patients’ gratifi cation is at a low level. Peritoneal dialysis patients, who do not get the infection, are satisfi ed with the dialysis method, and the patients’ limitations and problems are fewer, and they are relaxed and have more freedom.

Background: We need some simpler, cheaper, and less burdensome tools to investigate the severity of renal parenchymal involvement in children with clinical pyelonephritis. Objectives: The present study was designed to investigate the relationship between electrolyte changes with renal involvement as documented by dimercaptosuccinic acid (DMSA) scan in children with febrile urinary tract infection (UTI). Methods: This is a retrospective cohort study, involving 158 children aged two months to 14 years with febrile UTI admitted to Taleghani Hospital in Gorgan from 2018 to 2019. Their documents in hospital were analyzed. They were divided into two groups with positive or negative defects on DMSA scan. Clinical and laboratory data were studied. Statistical analysis was performed using SPSS version 18. Data were analyzed using independent t-test with normal distribution of variables, otherwise chi-square test was used. The statistical signifi cance level of the study was considered 0. 05. Results: Among the 158 children, 78 patients (49. 4%) had normal DMSA scan results, and 80 patients (50. 6%) had an abnormal result. The mean age in month was not diff erent between the two groups. In patients with positive renal cortical defects on DMSA scan (group 2), ESR was signifi cantly higher than the fi rst group (P < 0. 05). The mean serum Na level in the second group was lower than in the fi rst group; however, it was only slightly signifi cant (P = 0. 058). The two groups showed no diff erence with respect to serum potassium, urine specifi c gravity (SG), WBC count, and the duration of fever (P > 0. 05). The frequency distribution of proteinuria was not diff erent between the two groups (P = 0. 836). Conclusions: We suggest that increased ESR, positive CRP, and the presence of refl ux can predict renal parenchymal involvement in children with febrile UTI as evidenced by a positive fi nding on DMSA scan, and the presence of hyponatremia has a little predictive value in this regard.

Background: Restless legs syndrome is a neurological disorder in hemodialysis patients that causes disturbance and disability in rest, discomfort, sleep disturbance, fatigue, and stress. Objectives: This study was done to evaluate the eff ect of cold water bags on the severity of restless leg syndrome and sleep quality in hemodialysis patients. Methods: This is a quasi-experimental study (before and after) performed on patients referring to three hospitals in Yazd province. In this study, 40 patients with restless legs syndrome were selected from all patients who were referred to the hemodialysis ward by simple random sampling. The samples completed the Restless Legs Syndrome Symptoms Severity Questionnaire before and after using the cold water bag. Data were analyzed by SPSS 20 software and descriptive statistics and paired t-test at the signifi cance level of < 0. 05. Results: This study showed a signifi cant diff erence between the mean score of restless leg syndrome and sleep quality before and after the interventions (P = 0. 000). Furthermore, the mean scores of restless leg syndrome and sleep quality were diff erent between the two intervention groups and statistically signifi cant (P = 0. 000). Conclusions: Based on the results, using a water bag reduces the symptoms of restless leg syndrome. Therefore, it is suggested that cold water bags should be used as an eff ective, safe, low-cost method.

Objectives: Infectious central venous catheter (CVC) complications, including mortality and care and hospitalization costs, are still a major clinical concern. This study aimed to determine the prevalence of hemodialysis catheter infection and its risk factors among hemodialysis patients. Methods: The present research was a descriptive, prospective cross-sectional study on hemodialysis patients in Babol hospitals during 2020-21. The participants’ demographic information and some relevant data on clinical variables (namely underlying diseases, cause of dialysis, and cause of catheter removal) and catheter-related variables (namely catheter location, frequency of catheter placement, and apparent signs of catheter site) were collected and recorded directly and systematically during surgery post-surgery. Results: One hundred and twenty-two patients with temporary double-lumen acute hemodialysis catheters for dialysis, including 56 women (45. 9%), were included in this study, the mean age of whom was 58. 9  16. 4 years. Twenty-two patients (18%) developed a catheter-induced systemic infection. There was no signifi cant relationship between the catheter site and its removal inducing infection (P > 0. 05). The frequencies of microorganisms causing catheter infection included gram-positive Staphylococcus epidermis (59%) and Staphylococcus aureus (31. 8%). Moreover, there was no signifi cant correlation between demographic variables and clinical history with systemic infection induced by catheterization. Conclusions: The rate of catheter-induced infection is relatively high among patients since sterile instructions were observed during catheterization; therefore, it is recommended to pay more attention to the care and dressing of the catheter site.

Background: Coronavirus disease 2019 (COVID-19) has infected millions and caused tens of thousands of casualties. Epidemiologic studies show that specifi c individuals with pre-existing conditions are prone to severe disease caused by the virus. Thus, it is necessary to determine clinical signs and symptoms and disease progression course in various pre-existing conditions, namely end-stage renal disease (ESRD) patients undergoing hemodialysis. Methods: The present retrospective study was conducted on 17 ESRD patients undergoing chronic hemodialysis. Clinical signs and symptoms were extracted, and laboratory test results and imaging fi ndings were retrieved using the health information systems of the institute where the study was performed. Results: Of 17 patients in the study, six patients were females, and 11 were males. The mean age of the patients was 62. 29  15. 6 years (22-82). The most common pre-existing conditions were hypertension and diabetes. The most common imaging signs were groundglass opacities. The most common pattern of involvement was peripheral, bilateral, and multifocal involvement, and interestingly, uncommon imaging signs such as crazy-paving, peribronchovascular involvement, and reticulonodular pattern of involvement. The most common laboratory fi ndings were lymphopenia, lymphocytosis, increased erythrocyte sedimentation rate, and positive C reactive protein. Conclusions: ESRD patients undergoing COVID-19 seem to have higher mortalities than the general public and show more signifi cant lung involvement on chest CT imaging. Furthermore, uncommon imaging signs are more common in this group of patients.

Objectives: There are arguments regarding the relationship between the level of cardiac troponin I (cTnI) and presence of cardiac diseases in end-stage renal disease (ESRD) patients. This study aimed to determine the relationship between positivity of cTnI and cause of admission and patients’ outcome in ESRD patients. Methods: In this cross-sectional study, all ESRD patients who had checked cTnI and admitted to two university hospitals in Isfahan, Iran were enrolled. The patients’ demographic characteristics, cause of admission, and outcome were correlated with cTnI positivity. Results: Out of a total of 348 ESRD patients, 100 subjects had positive cTnI. There was a positive correlation between age and admission in Al-Zahra hospital with positive cTnI. In contrast, vascular access complication and hypertension had a negative correlation with positivity of cTnI. The results of multiple logistic regression analysis showed that factors including age (OR: 1. 04; 95% CI: 1. 01 1. 07; P: 0. 004) and infections (OR: 3. 1; 95% CI: 1. 3-7. 3; P: 0. 009) were associated with increased risk of in-hospital mortality. In contrary, exit site infection (OR: 0. 11; 95% CI: 0. 01-0. 8; P: 0. 03) and hypertension (OR = 0. 32; 95% CI: 0. 14-0. 77; P = 0. 01) were associated with decreased risk of mortality. Although cTnI positivity correlated with patients’ in-hospital mortality (OR = 2. 038). Conclusions: Although positive cTnI had a borderline association with in-hospital mortality in ESRD patients, further multicenter studies with larger sample size are required to confi rm the results.

Background: The present study aimed to evaluate the eff ect of cold dialysis solution on the sexual dysfunction of patients with chronic renal failure undergoing hemodialysis. Methods: This randomized clinical trial was conducted with a before and after parallel design among 60 hemodialysis patients diagnosed with sexual dysfunction. The selected subjects were randomly allocated to the two groups of experimental and control (30 per each). Patients in the experimental and control groups underwent hemodialysis for one month using 35. 5° C and 37° C dialysis solutions, respectively. Following the procedure, male and female sexual function was assessed in the study groups. Data were collected using the International Index of Erectile Functions, the female sexual function index (FSFI), and a demographic questionnaire. Data analysis was performed using chi-square, Fisher’ s exact test, Mann-Whitney U test, t-test, paired t-test, and Wilcoxon test at 95% confi dence interval. Results: No signifi cant diff erence was observed between the experimental and control groups regarding male sexual function before and after the intervention (P > 0. 05). However, the Mann-Whitney U test indicated a signifi cant diff erence in the female subjects’ arousal in the experimental group before (3. 68  0. 38) and after the intervention (3. 98  0. 46; z = 2. 216; P = 0. 027). Conclusions: Cold dialysis solution could only increase the sexual arousal of the women in the experimental group, and no changes were observed in other sexual function domains of the male and female patients. Given the short duration of our intervention, it is recommended that further longitudinal studies be performed on larger cohorts of patients in diff erent geographical regions.

Background: Prostate cancer is one of the leading causes of mortality in Iran and is the third most common cancer in male population. Objectives: The present study aimed to evaluate the necessity and effi cacy of establishing a specifi c rehabilitation center for patients with prostate cancer. Methods: In this basic-applied research, we proposed the establishment of a rehabilitation center to support and decrease the complications of various treatments in patients with prostate cancer. After entering the rehabilitation process, a well-educated nurse and general physician trained in one of the similar European centers supported the patients to help themselves cope with unresolvable symptoms. To evaluate the patients’ satisfaction with the services off ered by this rehabilitation center, the patients were asked to fi ll the Prostate Cancer-Related Quality of Life Questionnaire seven months after the fi rst session. Results: In this study, 133 patients with prostate cancer (71 persons in the control group and 62 persons in the conservative treatment group) underwent the analysis. The participants’ mean age was 62. 8  2. 31 years in the control group and 63. 3  4. 54 years in the treatment group (P = 0. 613). Moreover, the participants’ mean lifestyle scores were 5. 3  2. 5 and 5. 8  2. 8 in the control and treatment groups before the supportive care, respectively (P = 0. 460). However, following the intervention, the scores were 5. 3  2. 1 and 7. 6  1. 9 in the control and treatment groups, respectively (P = 0. 001). The mean lifestyle score was signifi cantly higher after supportive care in the treatment group (P = 0. 001). Conclusions: A prostate cancer-specifi ed rehabilitation center providing supportive care by an educated healthcare professional can signifi cantly improve the quality of life of patients with prostate cancer.

Background: Diabetic retinopathy (DR) is a visual impairment-related eye disease developed by long-term hyperglycemic status. Diabetic condition in DR patients leads to diabetic organopathies (e. g., renal failure). Albuminuria, as a hallmark of renal failure, can be correlated with visual indicators in DR patients. Objectives: This study aimed to investigate the role of albuminuria status in visual acuity (VA) and bevacizumab therapy outcomes in DR patients. Methods: In this retrospective study, 48 DR patients were admitted to the Ophthalmology Center of Ayatollah Rouhani Hospital, affi liated with Babol University of Medical Sciences, Babol, Iran. The retinopathy status and VA were identifi ed before and after treatment through 45 days of bevacizumab therapy. In addition, fast blood sugar, hemoglobin A1c, urine albumin, and urine creatinine were evaluated using standard laboratory methods. Results: The VA value before treatment in microalbuminuric DR patients (0. 106  0. 036) was signifi cantly lower than nonmicroalbuminuric DR patients (0. 347  0. 286; P < 0. 001). Furthermore, VA value after treatment in microalbuminuric DR patients (0. 115  0. 071) was signifi cantly lower than non-microalbuminuric DR patients (0. 355  0. 272; P < 0. 001). There was no signifi cant diff erence in the percentage of VA increase between microalbuminuric and non-microalbuminuric patients. Moreover, the albumin-to-creatinine ratio (ACR) was correlated with a lower VA level before and after treatment (P < 0. 001 for both). There was no correlation between the percentage of VA increase with ACR, albumin, and creatinine. Conclusions: The current study results showed that diff erent VA before and after bevacizumab therapy status was correlated with microalbuminuria status. Additionally, microalbuminuria status did not aff ect the percentage of VA increase in the treatment of DR patients.

Background: We aimed to evaluate the safety and effi cacy of 50-unit dose against 100-unit dose of intracavernosal injection (ICI) of AbobotulinumtoxinA (BTX-A) (Masport® ) in patients with vascular erectile dysfunction (ED) resistant to fi rst-line therapies, including phosphodiesterase type 5 inhibitors (PDE5I). Methods: In this double-blind randomized controlled trial (RCT), 40 patients with ED resistant to PDE5I were randomly divided into two groups: ICI of a single dose of Masport® 50 units and single dose of 100 units. Peak systolic velocity (PSV) confi rmed arterial insuffi ciency vascular disorder. For all patients, International Index of Erectile Function (IIEF), Sexual Health Inventory for Men (SHIM), and Erection Hardness Score (EHS) questionnaires were completed. Six weeks after the treatment, the subjects were reexamined. Results: Our results showed an acceptable clinical effi cacy and safety of ICI of Masport® six weeks after injection. No systemic complications in patients were seen. Three patients complained of brief penile pain shortly after injection, but there were no other local complications. The increase in mean PSV in the 100-unit group due to treatment was signifi cant (P-value < 0. 0001). Also, there was a signifi cant diff erence between the two groups of 50-and 100-unit (P-value < 0. 0001). In addition, the increase in mean IIEF-EF, SHIM score, and EHS due to treatment was signifi cant between the two groups. For the 100-unit group, P-value < 0. 0001 and the diff erence between the two groups was also signifi cant (P-value < 0. 0001), which indicated a better response to treatment in the 100-unit group. The mean increase of IIEF score (EF domain) was 4. 3 (mean IIEF: 9. 4 and 13. 7 after and before, respectively) in the 100-unit group and (mean IIEF: 8. 1 and 9. 1 after and before, respectively) in the 50-unit group. Conclusions: The results of this study showed that ICI of AbobotulinumtoxinA, especially at a dose of 100 units, in patients with refractory vasculogenic ED is safe and eff ective in improving sexual function and ultrasound indices.

Background: Chronic renal failure is the most common indication for which arterio-venous (AV) fi stula creation surgery is being performed. Various studies have found that native arteriovenous fi stulas are the best in long-term patency with lower complications. We conducted this study to fi nd out the role of preprocedural duplex ultrasound (DUS) in predicting outcomes of radiocephalic fi stula in the wrist in the North-Karnataka population. Methods: This prospective study was conducted from May 2019 to July 2020 on 50 patients who were hemodialysis-dependent and underwent AV fi stula creation with age from 20 to 70 years. All the patients underwent preoperative DUS and were followed up post-operatively after one, two, and six weeks. Hemodialysis was initiated through the constructed fi stula once it was mature, and the maximum blood fl ow through the fi stula was measured. SPSS version 20. 0 was used for statistical analysis. Results: Among 50 subjects, the overall cumulative success of AVF maturation was 86% (43), and failure to mature rate was 14% (7). Logistic regression of maturation outcome in the wrist autologous arteriovenous fi stula for individual factors showed statistically signifi cant results (P < 0. 05) for the diameter of the radial artery > 1. 6 mm and the distensibility of the cephalic vein > 0. 4 mm. Conclusions: Vein distensibility and radial artery diameter are key factors in predicting successful AVF maturation. The use of intraoperative papaverine instillation directly on vessels can improve arteriovenous fi stula outcomes.

Context: Delayed graft function (DGF) is an important clinical outcome following renal transplantation; therefore, it is important to be correctly diagnosed. The DGF is thought to correlate with the fi rst 24-hour urine output (UOP1), and this clinical sign is expected to predict DGF. Objectives: This study aimed to discover whether the UOP1 correlates signifi cantly to the DGF incidence and can be a DGF predicting factor. Data Sources: This study compared the incidence of DGF with the UOP1 reported by studies obtained from the electronic databases, namely MEDLINE, Cochrane, and EBSCO. Studies that performed multivariate or bivariate analysis and/or reported sensitivity and specifi city were included in this review. Results: A total of 1719 studies were obtained from the database search, and 2 studies were enrolled from other sources. Out of 1721 studies, 9 studies were recruited in this review, 5 of which reported sensitivity and specifi city. Overall, nine of these studies had a low to moderate risk of bias. Almost all studies reported a signifi cant relationship between the UOP1 and DGF. All studies agreed that the UOP1 is a sensitive predictive factor in predicting DGF. The specifi city reported by the studies examined in this review varied greatly. The use of optimum cut-off in each study is considered to be the cause of this variability. Conclusions: The UOP1 is signifi cantly related to the incidence of DGF and is a proper parameter for the prediction of DGF events.