Iranian Journal of Kidney Diseases
Year:2016 | Volume:10 | Issue:4|Papers Count:12

Advances in medical oncology has led cancer patients to live longer.Moreover, the field of molecular oncology is rapidly evolving, new therapies emerge, and drugs are approved quickly. This has led nephrologists to encounter new and partially unrecognized treatments of the targeted therapy agents with kidney adverse effects. These agents fall mainly into 2 categories affecting the vascular endothelial growth factor and endothelial growth factor pathways. This review covers the incidence of kidney disease induced by these agents, pathophysiologic mechanisms, and clinical presentation, and is the first to recommend an adequate management for each pathophysiology.

A 41-year-old nondiabetic nonhypertensive man presented with increased frequency of micturition and low-grade fever. He had a history of pulmonary tuberculosis and antitubercular drug therapy.Blood hemoglobin level was 7 g/dL; total leucocyte count, 14.2 × 103/L; and serum creatinine, 2.62 mg/dL. Leucocytes (25 to 30 per high-power field) and erythrocytes (1 to 2 per high-power field) were noted in urinalysis. Ultrasonography before admission had revealed a complex cystic mass measuring approximately 37 × 30 mm in the upper pole of the left kidney; noncontrast computed tomography had documented hemorrhage; and magnetic resonance urography had shown peripheral hypointense hemosiderin rim suggestive of chronic hemorrhage. Differentiation between a complex cystic renal cell carcinoma and infective etiology could not be made on the basis of imaging. Repeat ultrasonography (in 2 weeks) after admission revealed 20 × 22-mm avascular heteroechoic area in the upper pole of the left kidney, which had significantly reduced in size compared to the previous scan. This was consistent with resolving renal abscess. The patient did well on conservative management.

Introduction.Fluid management in critically ill patients with acute kidney injury (AKI) is controversial. Our study is aimed to evaluate the association between fluid balance and patient outcome in AKI patients admitted to intensive care unit (ICU).Materials and Methods.This prospective study was carried out at Lilavati Hospital and Research Centre on 130 critically ill patients with AKI admitted to ICU. Mean daily fluid balance (MDFB) was measured and its correlation with clinical characteristics and outcomes was assessed.Results.During ICU stay, 48.2% patients had a positive and 52.8% had a negative MDFB. In the patients with positive MDFB, mean ICU stay was longer and ventilation requirement, duration of ventilation, inotrope requirement, and duration of inotrope were greater as compared to the group with negative MDFB. A significantly higher mortality rate were observed in the patients with positive MDFB as compared to negative MDFB (43.5% versus 7.4%).Conclusions.Negative fluid balance was independently associated with a significant reduction in mortality, ICU stay, ventilator requirement, and the need for renal replacement among critically ill patients with AKI.

Introduction.The aim of this study was to investigate the possible renoprotective effect ofPlantago major extract against cisplatininduced nephrotoxicity in rats.Materials and Methods.Rats were divided into 6 groups. The first group was the control, group 2 was treated with cisplatin (7 mg/ kg, single dose), and groups 3 to 6 received cisplatin with vitamin E (100 mg/kg) andPlantago major extract at doses of 300 mg/kg, 600 mg/kg, and 1200 mg/kg, for 20 days.Results.On day12, serum concentration of urea, creatinine, and potassium significantly increased and sodium concentration significantly decreased in the cisplatin group compared with the control rats. However, serum creatinine, urea, and potassium concentrations were significantly lower in all of thePlantago major groups compared to the cisplatin group. Also, there was a significant elevation in serum sodium concentration in thePlantago major 600 mg/kg group compared to the cisplatin group on day12. Injection of cisplatin caused a significant elevation in malondialdehyde concentration but a significant decrease in catalase activity and total thiol content compared to the control group.Plantago major extract at 1200 mg/kg significantly improved malondialdehyde concentration and total thiol content compared to the cisplatin group. Catalase activity withPlantago major significantly increased at all doses compared to the cisplatin group.Conclusions.The current study suggests that Plantago major extract and vitamin E are able to improve kidney function as well as oxidative stress in cisplatin-induced renal toxicity in the rat.

Introduction.Gentamicin can lead to acute tubular injury and kidney dysfunction. This study aimed to evaluate the effect of Ferulago angulataon kidney function and other markers in rats with gentamicin-induced nephrotoxicity.Materials and Methods.Forty-eight male Wistar rats were divided into the following groups: group 1, the controls; group 2, rats receiving gentamicin (120 mg/kg body weight per day, intraperitoneal) for 7 days without treatment; groups 3, 4 and 5, rats receiving gentamicin for 7 days and oral treatment with 200 mg/kg, 400 mg/kg, and 800 mg/kg body weight per day of Ferulago angulateextract, respectively. Measurements included serum levels of creatinine, urea, uric acid, lipids, ferric-reducing antioxidant power, and protein carbonyl; kidney and serum levels of malondialdehyde; and serum and renal levels of tumor necrosis factor-a. Histopathology of kidney tissue was examined as well as renal catalase, superoxide dismutase, and vitamin C.Results.Compared to treatment with gentamicin only, treatment withFerulago angulata resulted in a significantly higher high-density lipoprotein cholesterol, ferric-reducing antioxidant plasma, renal catalase, superoxide dismutase, and vitamin C levels. It was also associated with significantly lower serum levels of creatinine, urea, uric acid, malondialdehyde, protein carbonyl, tumor necrosis factor-a, total cholesterol, triglyceride, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol.Ferulago angulatewas linked with a lower renal gene expression of tumor necrosis factor-a.Conclusions.The present study suggests that Ferulago angulate extract has protective effects against nephrotoxicity due to gentamicin.

Introduction.This study was performed to evaluate the effects of omega-3 fatty acid supplementation on inflammatory cytokines and advanced glycation end products (AGEs) in patients with diabetic nephropathy (DN).Materials and Methods.This randomized double-blind placebo controlled trial was done on 60 patients with DN who were randomly divided into 2 groups to receive either 1000 mg/d of omega-3 fatty acid from flaxseed oil (n=30) or placebo (n=30) for 12 weeks. The primary outcome variables were tumor necrosis factor-α, receptor tumor necrosis factor-α and growth differentiation factor 15. Fasting blood samples were taken at the onset and the end of the study to quantify the related markers.Results.Compared with the placebo, omega-3 fatty acid supplementation resulted in a significant decrease in serum AGEs (-2.3 ± 2.8 AU versus 0.2 ± 2.5 AU, P=.001). Despite a significant reduction in serum level of receptor for AGEs (-0.1 ± 0.3 AU, P=.02) in the omega-3 fatty acid group, no significant difference was found between the two groups in terms of their effects on the receptor for AGEs. Supplementation with omega-3 fatty acid had no significant effect on the inflammatory cytokines as compared with the placebo.Conclusions.Our study demonstrated that omega-3 fatty acid supplementation among DN patients had favorable effects on AGEs and the receptor for AGEs.

Introduction: This study aimed to evaluate the prevalence of vitamin D inadequacy in patients receiving maintenance hemodialysis and peritoneal dialysis (PD) and its association with inflammatory and nutritional factors.Materials and Methods: A total of 176 hemodialysis and 32 PD patients participated in the study. Serum levels of 25-hydroxyvitamin D, albumin, parathyroid hormone, calcium, phosphorus, highsensitivity C-reactive protein (HSCRP), and neutrophil-lymphocyte ratio (NLR) were measured. Data on body mass index were also collected. Stepwise multiple logistic regression analysis was used to identify predictors for 25-hydroxyvitamin D deficiency and its relationship with the nutritional and inflammatory factors.Results: No significant association was found between 25-hydroxyvitamin D and age, body mass index, serum calcium, serum phosphorus, parathyroid hormone, serum albumin, dialysis quality, and duration of dialysis; while NLR and HSCRP were significantly associated with 25-hydroxyvitamin D in the hemodialysis patients only (P<.001 and P=.001, respectively). A positive correlation was found between NLR and HSCRP in both hemodialysis and PD patients. (r=0.817; P<.001). This association was confirmed between an NLR greater than 3 and an HSCRP level greater than 3.Conclusions: Vitamin D deficiency was highly prevalent in our dialysis patients, and inadequate level of vitamin D was associated with inflammatory factors such as HSCRP and NLR in both hemodialysis and PD patients. An easy and inexpensive test of an NLR greater than 3 could be used as a measure of inflammation instead of HSCRP in both PD and hemodialysis patients.

Introduction.Urinary tract infection (UTI) is very common in children. Precocious diagnosis and appropriate treatment are important because of the permanent disease complications. Zinc increases the response to treatment in many infections. In this study, we explored the effect of zinc in treating UTI.Materials and Methods.Two hundred children with UTI were divided into 2 groups of 100 who were comparable in terms of age, sex, urine laboratory profiles, and clinical signs and symptoms.The control group received a standard treatment protocol for UTI and the intervention group received oral zinc sulfate syrup plus routine treatment of UTI.Results. A faster recovery was observed in the patients receiving zinc, but abdominal pain was exacerbated by zinc and lasted longer. Three months after the treatment, there was no significant difference between the two groups in the time of fever stop and negative urine culture.Conclusions. In children with UTI, zinc supplementation has a positive effect in ameliorating severe dysuria and urinary frequency while the use of this medication is not recommended in the presence of abdominal pain.

Introduction: The aim of this study was to evaluate ventricular geometry, its relationship with the inflammatory markers, and mortality of patients with end-stage renal disease on peritoneal and hemodialysis treatment.Materials and Methods: We enrolled adult patients on long-term dialysis (hemodialysis and peritoneal dialysis) for more than 3 months. Two-dimensional echocardiography was performed by an experienced cardiologist who was blinded to all clinical details of patients. Cardiovascular mortality was assessed during a 2-year follow-up period.Results: There were 129 participants, of whom 86 (66%) were on hemodialysis. Left ventricular hypertrophy was present in 86.7%; concentric hypertrophy was found in 64 (49.1%) and eccentric hypertrophy in 48 patients (37.2%). Patients with left ventricular hypertrophy were further divided into tertiles according to their left ventricular mass index. Logistic regression found pulse pressure as an independent risk factor associated with left ventricular mass index (odds ratio [OR], 1.04; 95% confidence interval (CI), 1.01 to 1.19; P=.047). Cardiovascular mortality rate was 15.5%.Multivariable analysis showed that C-reactive protein (OR, 1.06; 95% CI, 1.01 to 1.10; P=.01), pulse pressure (OR, 1.01; 95% CI, 1.0 to 1.26; P=.046), and left ventricular mass index (OR, 1.03; 95% CI, 1.01 to 1.21; P=.03) were independent risk factors for cardiovascular mortality.Conclusions: Concentric hypertrophy is the most frequent left ventricular geometry model in patients with chronic kidney disease.Inflammation, pulse pressure, and left ventricular hypertrophy are interrelated and all contribute to mortality and cardiovascular death risk among dialysis patients.

We studied plasma vitamin D level in 96 kidney transplant recipients and its circannual rhythm. Blood samples were tested for 25-hydroxy vitamin D, parathyroid hormone, creatinine, phosphate, and calcium levels in winter and summer 2014. The mean age was 41 years, and the mean transplant age was 6.1 years. Plasma levels of 25-hydroxy vitamin D were 18.0 ± 15.0 ng/mL in winter and 18.3 ± 14.7 ng/mL in summer (P=.64). Parathyroid hormone was inversely correlated with vitamin D level in both seasons (r=-0.044, P<.001). There was no relationship between vitamin D and other variables. Our study showed vitamin D deficiency is prevalent among kidney transplant recipients both in winter and summer.Also, vitamin D level did not rise from winter to summer. It is recommended to routinely check on kidney transplant recipients’ vitamin D status.

Chronic granulomatous disease is a rare primary immunodeficiency disorder, which leads to increased susceptibility to recurrent infections and severe inflammatory manifestations. There have been reports regarding different aspects of genitourinary involvement in chronic granulomatous disease, some of which are hydronephrosis, granulomatous cystitis, and glomerulonephritis, but among these complications, amyloidosis is rather rare. We report a patient with chronic granulomatous disease that developed amyloidosis later in the course of the disease.

Esophageal perforation is a rupture of the esophageal wall, caused by iatrogenesis in 56% of cases. Perforation of the esophagus remains a challenge, and its incidence has increased as the use of endoscopic procedures has become more frequent. We report a 54-year-old woman with esophageal perforation 8 days after kidney transplantation. She had received a gastrointestinal consultation prior to her transplantation. This report highlights the fact that perforation may occur after any organ transplantation, especially during the initial 2 weeks after transplantation, when mycophenolate mofetil and cyclosporine as well as and high doses of corticosteroid are administered. If there is a delay in passage and a swallowing difficulty, high doses of immunosuppressive drugs are likely to cause ulceration and perforation. Preventive strategies including intravenous steroids for the first 2 to 3 weeks and divided doses of pills should be considered for such patients.