Nephro-Urology Monthly
Year:2011 | Volume:3 | Issue:2|Papers Count:10

Although the introduction of cyclosporine (CyA) in the 1980s as maintenance immunosuppressive regimen in solid organ transplantation (1) revolutionized this field, the thera­peutic drug monitoring (TDM) of CyA to optimize efficacy and safety is still of clinical interest. During last 3 decades, no consensus has been attained yet on the criteria to derive benefit from the immunosuppressive efficacy, while limiting the side effects of CyA (2). As in clinical experiences, no rela­tionship could be found between administered doses and clinical effects, fixed doses of CyA were not the best way to use the drug. To avoid side-effects, therefore, monitoring of CyA blood level is mandatory to modify the individual doses of the drug. CyA exposure, as calculated by area under the curve (AUC), has been shown to correlate with clinical out­comes in kidney transplant recipients (3)….

Background: The evaluation of fluid status is generally approached from clinical observation of body weight changes, congestion, edema, blood pressure and chest X-ray. However, evaluation on clinical grounds alone is not accurate enough in HD patients; moreover, no single method has emerged as a gold standard to assess the fluid status in chronic hemodialysis patients. Objectives: The aim of this study was to assess the fluid status among chronic hemodialysis patients using Doppler echocardiographic parameters including inferior vena cava diameter (IVCD) and its correlation to plasma atrial naturetic peptide (ANP). Patients and Methods: Sixty subjects were included in this study, 40 patients on chronic hemodialysis and 20 subjects as control group. The subjects of this study were classified into three groups; group 1 , 20 normotensive patients who were on hemodialysis for at least six months; group 2, 20 hypertensive patients who were on hemodialysis for at least six months; and group 3, 20 healthy subjects without history of cardiac disease (as a control group). The IVCD was measured in all groups by ultrasound and Doppler echocardiography to estimate the pulmonary flow and post dialysis plasma atrial naturetic peptide (ANP). Results: A significant difference in the IVCD 2 hours after hemodialysis was seen between the hypertensive and the normotensive groups. In addition, we found that a significant difference in the peak pulmonary vein systolic velocity between the three groups. There was a significant negative correlation between the peak pulmonary systolic velocity to peak pulmonary diastolic and IVCD. In addition, there was a significant difference between mean ANP level among the three studied groups and the ANP was significantly correlated with IVCD in corresponding groups respectively. Conclusions: The current study showed an increase in the IVCD and ANP as well as an increase S/D ratio in hemodialysis patients with hypertension than normotensive hemodialysis cases and the controls. Thus we emphasize the importance of assessment of fluid status using Doppler echocardiographic parameters as pulmonary venous flow using S/D ratio.

Background: Cytomegalovirus (CMV) is an important viral pathogen in patients undergoing organ transplantation.Objectives: We aimed to develop a molecular qualitative PCR assay for the detection of CMV DNA in clinical samples from renal transplant recipients. Patients and Methods: Polymerase chain reaction (PCR) was performed for the assessment of CMV replication in two groups of renal transplant patients. Furthermore, the sensitivity of PCR for detection of CMV DNA from plasma relative to leukocyte was tested. Results: CMV DNA was detected in 33 (25.9%) samples of 127 renal transplant patients. From 33 patients with positive PCR test, 20 patients had clinical symptoms and 13 (33.4%) of the patients had no clinical symptoms of disease. Also, the sensitivity of PCR assay for detection of CMV DNA from leukocyte relative to plasma is more. Conclusions: The results suggest that The CMV PCR might be a useful tool for the early identi­fication of patients at high risk of developing CMV disease. Furthermore the best sample for identify CMV infection is peripheral blood leukocytes (PBL).

Background: Surgical treatment of urethral strictures includes numerous options such as dilation, internal urethrotomy, stenting and reconstructive surgical techniques. Short uncomplicated strictures are generally amenable to complete excision with primary anastomosis. We performed a retrospective evaluation and analysis of outcome in patients who underwent any kind of treatment for urethral strictures.Objectives: To evaluate and analyze the outcome in patients who underwent treatment for urethral stricture disease over the last 15 years (May 1993 to June 2008), at a tertiary care centre, as well as to determine the treatment option to be utilized in different varieties of urethral strictures.Patients and Methods: We reviewed 524 patients who underwent treatment for urethral stric tures between May 1993 and June 2008. Mean follow-up was 68 months. Preoperative evalua tion included clinical history, physical examination, urine culture, residual urine estimation, uroflowmetry, and retrograde and voiding cystourethrography. Since 2000 urethral ultrasound was also performed in all patients. Clinical outcome was assessed by comparing pre and post-operative investigation and patient satisfaction.Results: Stricture etiology was catheter induced (15.36%), blunt perineal trauma (59.2%), in strumentation (12%), spontaneous (3.52%) and infection (10%). Stricture length was 0 to1cm (in 9.92%) 1 to 2 cm (in 32%), 2 to 3 cm (17.28%), 3 to 4 cm (24%) or 4 to 5 cm (8.8%) more than 5cm (16%). The success rates in these procedures were 93.6% (TAU-Tunica albuginea urethroplasty), 94.4% (USPBA-U shaped Prostato-bulbar Anastomosis), 91.7% (BMSU-Buccal Mucosa urethro plasty), 90% (IOU-Internal optic urethrotomy), 90.35% (dilatation) and 81% (two staged urethro plasty). There were 129 patients (25.49%) who experienced ejaculatory dysfunction. Good and fair results were considered successful. Of 524 cases 480 (91.6%) were successful and 44 (8.4%) were treatment failures.Conclusions: We conclude that the treatment of urethral strictures should be individualized, taking into account the location, length and extent of spongiofibrosis.

Background: Chronic kidney disease (CKD) is a worldwide health problem. But despite to new routes of dialysis, mortality and morbidity is high. One of the most common symptom of CKD is anemia, especially is more obvious in stages 3 and 4. Objectives: In this study, the effects of erythropoietin on renal function were assessed by meas urement of serum creatinine level. Patients and Methods: Twenty three adult patients with CKD in the stages 3 and 4, enrolled in study and serum creatinine level was monthly measured three months before need to pre scribe the erythropoietin due to anemia resulting from CKD (hemoglobin less than 12g/dl) and continued 6 months after administration of the drug. Based on patients' needs, the drug was administered subcutaneously in a dose of 4000-6000 units per week so patients' hemoglobin level became more than 12g/dL. During the study, all patients who required to dialysis or kid ney transplantation were excluded from the study.Results: Mean of creatinine and 1/creatinine values in 4 states including three-month before intervention, time to intervention, and the three months after the intervention and the six month after the intervention were 2.17 and 0.50; 2.45 and 0.45; 2.41 and 0.47; 2.30 and 0.49 respectively which were not statistically significant. Conclusion: The administration of recombinant human erythropoietin in stage 3 and 4 of chronic kidney disease, improves anemia with no impact on renal function.

Background: Previously we conducted three cross sectional studies of epidemiology of end stage renal disease (ESRD) in El Minia Governorate. Objectives: The aim of study was to ascertain prevalence, etiology and risk factors for ESRD dur ing year 2007. Patients and Methods: Patients on renal replacement therapy (RRT) in El-Minia Governorate in 2007 was 1615. They were offered to participate in this study; standardized questionnaire was completed including demographics, family history, risk factors for ESRD, environmental expo sure to toxins, and causes of death. Results: Prevalence of ESRD was 367 per million populations. Renal replacement therapy was hemodialysis in 1550 (96%), peritoneal dialysis in 32 (2%) and renal transplantation in 33 (2%) patients. Only 950 (59%) of the patients included in the study, mean age was 47 ± 13 years, me dian 43, range (18 to 80), males Vs females (64% Vs 36%), death rate was 182/1000. Conclusion: This study indicates an annual increase of 59 new ESRD pmp patients than the study of year 2006.

Background: Epstein-Barr virus (EBV) can cause serious complications in kidney transplant patients. Current guidelines are recommended that both recipients and donors, be routinely tested for EBV IgG antibody before kidney transplantation.Objectives: The aim of the study was to evaluate the value of this recommendation. Patients and Methods: In a cross sectional study from February 2009 to March 2010, we evaluat ed donors and recipients who referred to our kidney transplant center. Routine pretransplante laboratory testes including EBV IgG and IgM antibody were performed. Results: A total of 112 people, 52 donors (29 male and 23 Female) and 60 recipients (38 male and 22 female) were included in the study. Mean age of donors and recipients were 31.3±6.7 years and 42.1 ± 12.57 years, respectively. Marker of HBV and HCV infections were positive in only 1 and 2 recipients and negative in all of donors. EBV IgG antibody was positive in 70 percent of recipi ents (n = 42) and 52 percent of donors (n = 27) but there was no statistically significant differ ence between them (p = 0 .053) and between males and females (p = 0.94). EBV IgM antibody was negative in 97 percent of recipients (n = 57) and 100 percent of donors (n = 67). Conclusion: The seroprevalence of EBV infection among candidate for kidney transplantation in khuzestan is not very high compared to other provinces in Iran, although we should perform screening for EBV to avoid kidney donation from seropositive donor to seronegative recipient.

Background: Botulinum-A toxin (BTX) administration appears to be useful in patients with high pressure neurogenic bladder.Objectives: The aim of this study was to evaluate the usefulness of cystoscopic injections of BTX in the detrusor wall in the treatment of children with overactive neurogenic bladder dysfunctions. Patients and Methods: The prospective, non-placebo controlled study was conducted with the approval of Local Ethics Committee. The study group consisted of 31 girls and 34 boys with neurogenic bladder overactivity, aged from 1 to 14 and treated with Botulinum-A toxin (Dys port, Ipsen). Results: Both values of volumes of the catheterized urine and bladder volumes in urodynamic studies increased significantly after the therapy and it proved that the younger patient the more effective the percentage of volumes growth. Conclusion: The results showed that endoscopic administration of BTX improved functional parameters of urinary bladder in cases of children with neurogenic bladder and the method might represent an alternative approach to operative reduction of intravesical pressures.

The diagnosis of emphysematous cystitis is made when gas is visualized within the bladder wall on radiologic or ultrasound imaging and typically develops as a complication of lower urinary tract infection from gas forming bacteria. Its presentation varies from being asymptomatic to severe abdominal pain and requires a high index of suspicion in susceptible individu-als to make the diagnosis and avoid potentially serious complications. Here we present a case of emphysematous cystitis along with a brief review of the literature.

We report a case of early onset recurrent preeclampsia in a patient with positive family history of preeclampsia and a newly discovered acute intermittent porphyria. A 28 years old patient was admitted to our Clinic, due to early onset of preeclampsia in her third pregnancy. She had refractory hypertension with tachycardia, facial flush, anxiety and difficulty in breathing. During hospitalization, she reported occurrence of opalescent orange to reddish morning urine, which turned dark after a while. The dipstick test revealed positive urobilinogen in the urine. The same sample of urine was tested for porphobilinogens in the urine (by the use of Ehrlich's reagent) which were found positive and also porphyrins which were found negative; therefore, her medication was switched to a beta blocker. She decided to terminate pregnancy and this was done in the next few days by the use of anesthetics that are approved for acute inter mittent porphyria. At her checkup one month after delivery, her blood pressure was stabilized and the coproporphyrine, porphobilinogen and porphyrins from single void urine were all negative. In the checkup 2 months after delivery, proteinuria of 0.5 g/day was still present; however, it reached to normal range (1g/day) after six months. To our knowledge, this is the first case reported in the literature where superimposed preeclampsia occurs in a patient with newly discovered acute intermittent porphyria.