Iranian Journal of Kidney Diseases
Year:2017 | Volume:11 | Issue:2|Papers Count:13

Renovascular disease includes renal artery stenosis, renovascular hypertension, and azotemic renovascular disease (ischemic nephropathy). Renovascular hypertension is defined as an elevated blood pressure caused by renal hypoperfusion, usually resulting from anatomic stenosis of the renal artery and activation of the renin-angiotensin system. It accounts for 1% to 2 % of all cases of hypertension in the general population and 5. 8 % of secondary hypertension, but it plays a major role in treatable causes of hypertension in the young individuals. Although renovascular stenosis is a common and progressive disease in patients with atherosclerosis, it is a relatively uncommon cause of hypertension in patients with mild hypertension. In contrast, renal artery stenosis is more frequent in certain high-risk populations. Early diagnosis of renovascular hypertension and timely implementation of appropriate therapeutic procedures ensures optimum control of blood pressure, prevents ischemic nephropathy progression, and prevents the development of cardiovascular morbidity and mortality in the hypertensive patient population. As with most complex disorders, management decisions must be highly individualized for patients with renovascular disease. It is essential to consider renal arterial disease as one aspect of atherosclerotic disease.

Introduction. Chronic kidney disease is a public health problem worldwide that is highly associated with psychological disorders. This study aimed to assess prevalence of depression in hemodialysis patients in Iran. Materials and Methods. Relevant studies were identified from the PubMed, ISI Web of Science, Ovid, Scopus, EMBASE, and Iranian databases including Magiran, SID, IranMedex, and Irandoc, up to December 2015. The DerSimonian-Laird random effects model was employed to estimate the overall pooled prevalence. Heterogeneity was investigated and subgroup analyses were carried out by sample size and time of study. Results. Twenty-seven studies on 2822 patients met the inclusion criteria for analysis. The pooled analysis of depressive symptoms in hemodialysis patients in Iran was estimated to be 62% (95% confidence interval, 0. 54 to 0. 71) with a maximum rate of 95% (95% confidence interval, 0. 88 to 1. 02) and a minimum rate of 9% (95% confidence interval, 0. 02 to 0. 16). Statistical heterogeneity was high (I2 = 96. 9%). Conclusions. The results of this study showed that depression is common among dialysis patients in Iran. Early diagnosis and effective treatment of depression can improve quality of life, prognosis, and survival of patients.

Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes mellitus, cardiovascular disease, and also for chronic kidney disease. A high body mass index is one of the strongest risk factors for newonset chronic kidney disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing chronic kidney disease in the long-term. The incidence of obesity-related glomerulopathy has increased 10-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year, the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that make preventive behaviors an affordable option.

Introduction. Although preventative nephrology is the effective management of childhood kidney diseases, it is hard to provide it in this undesirable conditions. In this study, we aimed to document the kidney disease profile of Syrian refugee children admitted to our hospital. Materials and Methods. One hundred and thirty Syrian refugee children were admitted to the Pediatric Nephrology Department of the University of Gaziantep from September 2012 to January 2015. Demographic data, history, symptoms, physical examination findings, laboratory investigations, diagnosis, disease outcome, and therapeutic procedures such as peritoneal dialysis and hemodialysis were obtained from patient files. Results. Of the 130 admitted children, 74 were girls (59. 6%). The average age was 6. 97 ± 4. 2 years (range, 1 month to 17 years). Congenital abnormalities of the kidney and urinary tract were found in 34 children (26. 2%). Other morbidities were chronic kidney disease in 30 (23. 1%), nephrotic syndrome in 24 (18. 5%), urolithiasis in 9 (6. 9%), acute kidney injury in 4 (3. 1%), glomerulonephritis in 5 (3. 8%), enuresis in 12 (9. 2%), and others in 12 (9. 2%). Conclusions. Congenital abnormalities of the kidney and urinary tract and chronic kidney disease were highly prevalent in Syrian refugee children. Although free health care have been provided to all of these children, the continuation of political crisis and instability would increase the number of admissions and affect the quality of life of those children in a different environment from the home country.

Introduction. This study aimed to determine predictors of outcomes in critically ill patients with acute kidney injury (AKI), and to study the impact of the Charlson Comorbidity Index (CCI) as a prognostic indicator. Materials and Methods. This retrospective study included critically ill patients who were admitted with AKI or developed AKI during their hospital stay. The impact of comorbidity was evaluated by the CCI, while severity of AKI was assessed by the RIFLE criteria. Results. The mean age of 786 patients with AKI was 59. 0 ± 17. 0 years (59% men). The most common cause was sepsis in 51% of the patients. In-hospital mortality rate was 42%. The need for mechanical ventilation (odds ratio [OR], 1. 93; 95% confidence interval [CI], 1. 23 to 3. 04), vasoactive drugs (OR, 9. 67; 95% CI, 6. 35 to 14. 73), dialysis (OR, 1. 78; 95% CI, 1. 14 to 2. 78), failure class of RIFLE criteria (OR, 2. 02; 95% CI, 1. 00 to 4. 08), and a CCI greater than 6 (OR, 2. 20; 95% CI, 1. 38 to 3. 52) were independently associated with mortality. At 90 days of follow-up, 6% of the patients were dialysis dependent, while 32% and 62% had partial and complete recovery, respectively. In multivariable analysis, a CCI greater than 6 (OR, 0. 47; 95% CI, 0. 26 to 0. 83), need for dialysis in hospital (OR, 0. 31; 95% CI, 0. 17 to 0. 54), and failure class (OR, 0. 19; 95% CI, 0. 07 to 0. 55) were independent predictors of poor renal outcomes. Conclusions. The CCI independently predicts in-patient mortality and poor renal outcomes in patients with AKI.

Introduction. Doxorubicin and cyclophosphamide are widely used anticancer drugs with substantial toxicity in noncancerous tissue resulting from oxidative damage. Quercetin is a potent antioxidant compound. We hypothesized that quercetin administration would ameliorate the toxic effects of doxorubicin and cyclophosphamide prior to pregnancy. Materials and Methods. Cyclophosphamide, 27 mg/kg, and doxorubicin, 1. 8 mg/kg, were administered to rats as intraperitoneal doses once every 3 weeks for a total of 10 weeks with or without concurrent treatment with quercetin, 10 mg/kg/d. Oxidative stress parameters were evaluated in maternal kidney and liver tissues after gestation. Results. Doxorubicin was associated with elevated kidney tissue malondialdehyde relative to the controls and quercetin only treatment (P <. 05). Both cyclophosphamide and doxorubicin were associated with elevated malondialdehyde levels in the liver tissue (P <. 05). Doxorubicin treatment was associated with decreased liver glutathione peroxidase (P <. 05). Quercetin treatment suppressed the accumulation of malondialdehyde and increased glutathione peroxidase levels during doxorubicin and cyclophosphamide treatment (P <. 05) Conclusions. Treatment with quercetin in patients receiving doxorubicin and cyclophosphamide results in therapeutic restoration of homeostatic expression of the antioxidant parameters, reducing oxidative damage to the liver and kidney.

Introduction. Renal involvement is a rare complication of β-thalassemia. Both tubular and glomerular dysfunction might occur in these patients. The aim of this study was to evaluate and compare kidney function in the major, intermedia, and minor variants of β-thalassemia. Materials and Methods. Renal tubular and glomerular function of 72 patients with β-thalassemia (25 major, 23 intermedia, and 24 minor) were evaluated. Patients older than 40 years and those with chronic kidney disease, diabetes mellitus, congestive heart failure, associated infections, congenital anomalies of the kidney and urinary tract were excluded. Blood and urine samples were collected electrolytes and markers of kidney function. Results. Mean age at the time of study was significantly higher in the minor group. The majority of patients with thalassemia major were males. Hematuria and pyuria occurred in 4% to 8% of the patients. Serum level of all variables were within normal limits, with no significant difference between the three groups. Glomerular filtration rate was nonsignificantly higher in the major and intermedia groups, compared to the minor variant. A significantly lower urine phosphorus and uric acid excretion was noted with the minor variant. Urine phosphorus and uric acid excretion increased more frequently in the major and intermedia groups. Conclusions. Tubular and glomerular functions appear to be well preserved in all variants of β-thalassemia.

Introduction. Cystinuria is an inherited disorder affecting luminal transport of cystine and dibasic amino acids. Because of the poor solubility of cystine in urine, stone formation in the kidney occurs frequently. Cystinuria is associated with mutations in the SLC3A1 and SLC7A9 genes. Despite the population-specific distribution of mutations in the SLC7A9 genes, there are few genetic data reported for cystinuric patients from the Middle East. Materials and Methods. Exon 4 of the SLC7A9 gene was sequenced in 21 patients with cystinuria, using the polymerase chain reaction and sequencing methods. Results. A new variation in exon 4 of the SLC7A9 gene was identified, which was insertion of 1 adenine nucleotide between 2 cytosine nucleotides in position c. 272-273 insA. Conclusions. It seems to be important since it causes frame shift and it may be an important cause to make disease.

Introduction. Thymoquinone is a phytochemical compound found in the plant Nigella sativa. It has various pharmacological effects such as antioxidant and anti-apoptotic. Morphine can increase the generation of free radicals. It is mainly excreted through the kidneys and causes disturbing effects. This study was designed to evaluate protective effects of thymoquinone against morphineinduced damages to the kidneys of mice. Materials and Methods. Various doses of thymoquinone (4. 5 mg/ kg, 9 mg/kg, and 18 mg/kg) were intraperitoneally administered along with morphine to 48 male mice for 20 consequent days. These mice were compared with a control group with saline injection, morphine group, and groups with same doses of thymoquinone only (n = 6 in each group). Blood urea nitrogen, serum creatinine, and serum nitric oxide levels, as well kidney weight and histology were assessed after the interventions. Results. Morphine administration significantly decreased kidney weight and the number and mean diameter of the glomeruli. Increased levels of blood urea nitrogen, serum creatinine, and serum nitric oxide were also noted with morphine compared to the control group (P <. 05). However, administration of thymoquinone and thymoquinone plus morphine significantly enhanced kidney weight, number and mean diameter of the glomeruli. All of the groups with thymoquinone were also associated with reduced blood urea nitrogen, serum creatinine, and serum nitric oxide levels compared to the morphine group (P <. 05). Conclusions. It seems that antioxidant and anti-apoptotic effects of thymoquinone could protect of the kidneys against damage due to morphine toxicity.

Introduction. The kidney is the main source of serum Klotho production. Immunosuppressive agents could affect the kidney in this regard. The effect of the ACE gene polymorphism on Klotho production is a less studied area. This study aimed to assess serum Klotho and ACE gene in a group of stable kidney transplant recipients. Materials and Methods. In a cross-sectional study, 30 kidney transplant recipients with stable allograft function and 27 healthy young individuals were assessed for their serum Klotho levels. The ACE gene polymorphisms were studied in both groups. Results. Klotho level was higher in kidney transplant recipients than the controls, but the difference was not significant (2. 76 ± 2. 41 ng/mL versus 2. 01 ± 1. 41 ng/mL, respectively). In both groups, serum Klotho level was higher in those with the I>I polymorphism, the men, those with higher glomerular filtration rate, and younger individuals, but the differences did not reach a significant level. Higher body mass index was significantly associated with lower serum Klotho level in both groups. Conclusions. Klotho level after kidney transplantation meets the range in healthy individuals, and it is not affected by the ACE gene polymorphism.

Introduction. Ultrasonography is the preferable imaging technique for monitoring and assessing complications in kidney allograft transplants. Computer-aided diagnostic system based on texture analysis in ultrasonographic imaging is recommended to identify changes in kidney function after allograft transplantation. Materials and Methods. A total of 61 biopsy-proven kidney allograft recipients (11 rejected and 50 unrejected) were assessed by a computer-aided diagnostic system. Up to 270 statistical texture features were extracted as descriptors for each region of interest in each recipient. Correlations of texture features with serum creatinine level and differences between rejected and unrejected allografts were analyzed. An area under the receiver operating characteristic curve was calculated for each significant texture feature. Linear discriminant analysis was employed to analyze significant features and increase discriminative power. Recipients were classified by the first nearest neighbor classifier. Results. Fourteen texture features had a significant correlation with serum creatinine level and 16 were significantly different between the rejected and unrejected allografts, for which an area under the curve values were in the range of 0. 575 for difference entropy S(4, 0) to 0. 676 for kurtosis. Using all 16 features, linear discriminant analysis indicated higher performance for classification of the two groups with an area under the curve of 0. 975, which corresponded to a sensitivity of 90. 9%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 98. 0%. Conclusions. Texture analysis was a reliable method, with the potential for characterization, and can help physicians to diagnose kidney failure after transplantation on ultrasonographic imaging.

Aluminum phosphide poisoning is common in our region. It can cause severe metabolic acidosis and persistent hypotension, which lead to cardiogenic shock and subsequently mortality. Oliguric or anuric acute kidney injury is seen in almost all patients with aluminum phosphide poisoning. Renal replacement therapies are recommended in these patients to improve metabolic acidosis and increase the rate of survival. We report 2 cases of severe acute aluminum phosphide poisoning treated successfully with peritoneal dialysis.

Dear Editor: We read with interest the article entitled “ Clinical and Biochemical Parameters of Hemodialysis Patients before and during the Islamic Ramadan Month, ” which has published in your esteemed journal by Imtiaz and colleagues. 1 In this study, fasting effect on 282 hemodialysis patients was assessed by Imtiaz and colleagues during Ramadan month. Fasting was suggested by this study to be safe for hemodialysis patients since no significant changes in systolic blood pressure, serum potassium, and body weight were detected. Additionally, reduced levels of serum phosphorus and diastolic blood pressure were observed.