Nephro-Urology Monthly
Year:2016 | Volume:8 | Issue:3|Papers Count:10

Background: High incidence of premature ventricular contractions (PVCS) and arrhythmia during and soon after dialysis have been demonstrated by Holter monitoring.Objectives: In this study, the effects of dialysis and renal transplantation on Tpe, Tpec (corrected Tpe), QTc (corrected QT), QTd (QT dispersion), and Tpe/QT parameters asknownfactors in arrhythmogenicity, and also the correlation between electrolyte and arterial blood gas changing within these parameters will be assessed.Patients and Methods: In a retrospective study, 42 renal transplant recipients were selected. Under the supervision of an electrophysiologist, information related to Tpe, Tpec, Tpe/QT, QTd, and QTc parameters before dialysis (pre-HD), after dialysis (post-HD), and two weeks after transplantation (RTX) were analyzed. Electrolyte and arterial blood gas information were also recorded. Bonferroni adjustment, repeated measures ANOVA, generalized linear models, and generalized estimating equations were used for analysis.Results: Two weeks after transplantation, the mean Tpe decreased to 0.0520.002, which was significant compared to pre-HD (P< 0.001) and Post-HD (P=0.019). The mean Tpec was 0.0590.002, which, just in comparison to pre-HD, was significant (P=0.005).In addition, the mean Tpe/QT decreased to 0.1430.005, which was significant compared to pre-HD (P=0.018). The mean QTd was 0.0660.004, which wasn’t significant compared to before or after dialysis. The mean QTc decreased to 0.3860.004, which was significant compared to post-HD (P=0.0003).Conclusions: Taking the role of Tpe and Tpe/QT in arrhythmia into account and amending it by a successful transplantation can be considered as a factor that decreases arrhythmia after renal transplantation compared to ESRD patients.

Background: Chronic kidney disease (CKD) is defined as either kidney damage or a decline in renal function as determined by a decreased glomerular filtration rate (GFR) for three months or longer. CKD is an important risk factor for mortality.Objectives: The aim of this study was to evaluate the effects of CKD on renal-hepatic functional indices and blood pressure in 5.6 nephrectomized (5.6 Nx) rats over the course of nine months.Materials and Methods: Male Wistar rats were subjected to either 5.6 Nx or sham operations (n=8). Members of the sham group underwent the same procedure without surgical reduction of the kidney mass. For all animals, body weight (BW), serum creatinine (Cr), blood urea nitrogen (BUN), alanine transaminase (ALT), and aspartate transaminase (AST) levels were measured before and after surgery. After two-, three-, six-, and nine-month intervals, blood was collected to assay renal and hepatic functional indices.Tail-cuff blood pressure was recorded in each month after surgery.Results: BW was lower for the 5.6 Nx group rats after the operations compared with the BW of those in the sham operation group.Furthermore, the 5.6 Nx group showed elevations in blood pressure, Cr, BUN, ALT, and AST levels compared with the sham group over the course of time.Conclusions: In summary, CKD induced by the 5.6 Nx model caused hypertension and increased serum levels of Cr, BUN, ALT, and AST. These changes are augmented by the progress of time.

Background: Contrast-induced nephropathy (CIN) is one of the most important complications of angiography in patients with chronic kidney disease (CKD) or diabetes mellitus. The prevention of CIN can decrease therapeutic costs and hospital stays. There is controversy in the literature over the preventive effect of statins on CIN.Objectives: This study was designed to evaluate the preventive effect of atorvastatin on CIN after angiography in CKD and diabetic patients.Patients and Methods: In this placebo-controlled, double-blind clinical trial, patients with diabetes mellitus or CKD (15<GFR<60 mL/min, Cr>1.5 mg/dL) and an age range of 55 - 75 years candidated for angiography were included. The patients were randomized to 2 groups: one group receiving atorvastatin (80 mg/d from 48 h before angiography) and the other one receiving a placebo. All the patients received intravenous isotonic saline and N-acetylcysteine. CIN was defined as an increase in serum creatinine more than 0.5 mg/dL or more than 25% from the baseline values.Results: Totally, 220 patients at a mean age of 63.858.89 years and a mean body mass index of 31.415.99 kg/m2 were evaluated.In comparison of before-after values, there was a significant increase in serum creatinine in the placebo group (P=0.000). The incidence of CIN was significantly higher in the control group 24 hours after angiography (P=0.010); however, at a 48-hour interval, there was no significant difference in CIN between the 2 groups.Conclusions: Standard hydration and N-acetylcysteine and atorvastatin (80 mg) reduced the incidence of CIN, and this regimen was more effective than was the regimen of hydration and N-acetylcysteine (without atorvastatin) in decreasing CIN. Accordingly, it is reasonable to prescribe atorvastatin before angiography in high-risk patients.

Background: One of the most prevalent problems in hemodialysis patients is sleep disturbance. Poor sleep quality has unpleasant bio-psycho-social outcomes. The positive effects of implementing the continuous care model (CCM) were verified with different variables, including sleep quality. This study was done with different populations, using two groups.Objectives: This study aims to identify the sleep quality of hemodialysis patients in the city of Ilam and determine the effects of CCM on sleep quality.Patients and Methods: We performed a quasi-experimental research study with 56 hemodialysis patients at the Shahid Mostafa Hospital in Ilam during 2014 and 2015. Pretests and posttests were conducted with the study groups and the control groups. Pretests were conducted over a one-month period, then repeated immediately before the study. Posttests were conducted immediately after the study and then repeated one month later. Participants were selected by census method and randomly divided into two groups.Ethical considerations were observed. Based on the continuous care model, interventions were performed through educational sessions over a three-week period. Consultations for continuous sleep monitoring, controls, and evaluations were conducted with the study group over the next nine weeks. Data were gathered from patient demographics questionnaires and PQSI, then introduced in SPSS 22 and analyzed with descriptive and analytic statistics (t-paired, ANOVA with repeated measures, follow-up tests such as SN-K, Duncan, Sheffe and Tukey).Results: One month prior to the study, 94.6% of the participants suffered from poor sleep quality. Immediately before and after the study, 91% complained of poor sleep quality. And one month after intervention, the figure dropped to 82%. Applying the CCM positively affected the sleep quality of hemodialysis patients in Ilam, and was statistically meaningful one month after intervention (P=0.001).Conclusions: Hemodialysis patients need a consistent care plan to manage poor sleep quality. This research has proven the effectiveness of implementing CCM as an intervention for improving the sleep quality of hemodialysis patients. CCM provides a comprehensive model for caring for hemodialysis patients, and its executive stages are congruent with the many stages of the nursing process. Practitioners in different domains of nursing care, education, and management can derive great benefit from this valuable care model.

Background: Many methods have been used for preventing and reducing recurrences of bladder cancers. In recent years, some investigators have examined the use of metformin for this purpose. First lines of evidence have shown that metformin inhibits cancer cell growth and prevents cancer occurrence in patients with type 2 diabetes.Objectives: This study is designed to assess metformin usage in the prevention of bladder cancer recurrence after the trans-urethral resection of a bladder tumor (TUR-T).Patients and Methods: In the present study, metformin was administered in the treatment of 32 patients with a history of bladder cancer, and their results were compared with those of 33 patients with bladder cancer recurrence (placebo group). Patients in the metformin group received 1000 mg metformin (2 tablets 500 mg) for 1 year. Frequency of tumor recurrence was calculated and compared with the placebo group.Results: There was no statistical difference between the 2 groups with respect to the recurrence rate (P>0.05). Although the recurrence interval was longer for the metformin group, this increase was not statistical significant (P>0.05). Furthermore, tumor recurrence had no correlation with sex or the grade of the tumors.Conclusions: According to our findings, it seems that metformin has no considerable inhibitory effect on the recurrence rate of bladder cancer, but that it can delay tumor recurrence.

Sarcopenia and physical inactivity synergistically progress in patients with chronic kidney disease (CKD) and are strong predictors of mortality in this population. Exercise training and essential amino acids and vitamin D supplements may contribute to improving sarcopenia and physical inactivity in CKD patients.

Double-J (DJ) stents are the main tools used in urological practice for prevention and treatment of obstruction. Stenting is also mandatory after complicated ureteroscopy or TUL (Transureteral Lithotripsy). Known complications are upper migration of DJ stents into the kidney and lower migration to the bladder. In a man with an impacted right lower ureteral stone, a DJ stent was placed because the ureteroscope was not passed from an intramural ureter. We reported a very rare complication of DJ ureteral stent placement with intravascular migration to the pulmonary arteries, which was removed percutaneously through the right femoral vein under fluoroscopic guidance.

Background: Prostate cancer is the second mostcommonmalignancyamongmenworldwide and the sixth cause of cancer-related death. Some authors have reported a relationship between perineural invasion (PNI), Gleason score, and the invasion of peripheral organs during prostatectomy. However, it is not yet clear whether pathological evidence of PNI is necessary for risk stratification in selecting treatment type.Objectives: The clinical and pathological stages of prostate cancer are compared in patients under radical prostatectomy and in patients without perineural invasion.Patients and Methods: This cross-sectional study was conducted using a sample of 109 patientswho attended a tertiary health care center from 2008 to 2013. The selection criteria were PNI in prostate biopsy with Gleason scores less than six, seven, and eight to ten.The participants were enrolled in a census manner, and they underwent clinical staging. After radical prostatectomy, the rates of pathological staging were compared. The under-staging and over-staging rates among those with and without perineural invasion in biopsy samples were compared.Results: The concordance between Gleason scores according to biopsy and pathology was 36.7% (40 subjects). The concordance rate was 46.4% and 33.3% among those with and without PNI, respectively. The concordance rates were significantly varied in different subclasses of Gleason scores in patients without PNI (P=0.003); the highest concordance rate was a Gleason score of 7 (63.6%) and the lowest was a Gleason score of eight to ten (25%). However, there were no significant differences in patients with PNI (P>0.05).Conclusions: Although the presence of PNI in prostate biopsy is accompanied by higher surgical stages, PNI is not an appropriate independent factor in risk stratification.

Background: Renal transplantation is the ideal method for management of end-stage renal disease. The use of living donors for renal transplantation was critical for early development in the field and preceded the use of cadaveric donors. Most donors are related genetically to the recipients, like a parent, a child, or a sibling of the recipient, but there are an increasing percentage of cases where donors are genetically unrelated like spouses, friends, or altruistic individuals. Donor shortages constitute the major barrier for kidney transplantation, and much effort has been made to increase the supply of living donors. The impact of donor source on the outcome of renal transplantation is not adequately studied in our country.Objectives: The aim of the study was to evaluate the impact of donor source on the outcome of live donor kidney transplantation.Patients and Methods: From March 1976 to December 2013, the number of patients that underwent living renal transplantation sharing at least one HLA haplotype with their donors was 2, 485. We divided these patients into two groups: (1) 2, 075 kidney transplant recipients (1, 554 or 74.9% male and 521 or 25.1% female) for whom the donors were living related, (2) 410 kidney transplant recipients (297 or 72.4% male and 113 or 27.6% female) for whom the donors were living unrelated. All patients received immunosuppressive therapy, consisting of a calcineurin inhibitor, mycophenolate mofetil, or azathioprine and prednisolone. We compared acute rejection and complication rates, as well as long-term graft and patient survival of both groups. Demographic characteristics were compared using the chi-square test. Graft survival and patient survival were calculated using the Kaplan-Meier method.Results: The percentages of patients with acute vascular rejection were significantly higher in the unrelated group, while percentages of patients with no rejection were significantly higher in the related group, but there were no significant differences regarding patient and graft survivals between both groups.Conclusions: Kidney transplant recipients who received their grafts either from live related donors or live unrelated donors had comparable patient and graft survival outcomes.

Background: Hemodialysis patients are potentially susceptible to infection with blood-borne viral agents, especially hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).Objectives: The aim of this study was to evaluate the prevalence and incidence of HBV, HCV, and HIV infections in hemodialysis patients.Patients and Methods: This study was carried out in 482 hemodialysis patients who had been referred to eight dialysis centers in the Mazandaran province in Iran from 2012 - 2014. HBs Ag, HCV Ab, HBs Ab and HIV Ab were assessed every three months for two years. The patients’ demographic characteristics, including age, gender, area of residence, and duration of dialysis, were noted. The prevalence of each virus was also determined.Results: From a total of 482 patients, 253 (52.5%) males and 229 (47.5%) females were evaluated. The mean age of all patients was 54.9616.1 years, and all participants were HIV negative. One subject had both HBV and HCV infections. HBs Ag and anti-HCV were detected in 10 (2.1%) and 40 (8.27%) patients, respectively. The mean age of HCV-positive patients was 55.416.4, while HCV-negative patients were an average of 51.610.7 years old (P=0.002). The incidence of HCV was higher in people from 40–59 years of age (P< 0.001). No patients had HBV, and incidence of HCV was 0.5% in the first year and 0.75 in the second year. No cases of HIV were identified.Conclusions: The results show that the prevalence rates of HBV and HCV in hemodialysis patients were moderate to low in the Mazandaran province. Based upon the obtained levels of these viruses, these incidence rates are therefore reasonable.