Nephro-Urology Monthly
Year:2016 | Volume:8 | Issue:5|Papers Count:10

Background: Central dialysate fluid delivery systems (CDDS) are used by dialysis centers in Japan, and although these systems are effective at delivering dialysate, they have a complex piping network with numerous sites where contamination can develop. In Japan, cleaning disinfectants have been clinically evaluated based on endotoxin levels and bacterial counts, but there have been no published studies evaluating the biofilm removal efficacy of these agents at the electron microscope level.Objectives: In this study, we used electron microscopy to evaluate the effectiveness of various cleaning disinfectants in removing biofilms from hemodialysis piping.Methods: Liquid nitrogen was used to sever a section of dialysis piping on which a biofilm had formed during clinical use. Sodium hypochlorite, acetic acid, and peracetic acid were used at stock-solution concentrations as cleaning disinfectants. These disinfectants were tested at room temperature and when heated (80°C). After cleaning and disinfection, biofilm removal from the surface of the piping was evaluated using a scanning electron microscope (SEM).Results: Sodium hypochlorite did not show good biofilm removal at room temperature or when heated. Acetic acid was more effective at biofilm removal when heated than at room temperature. Peracetic acid was highly effective at biofilm removal at both room temperature and when heated Conclusions: Cleaning and disinfection using a disinfectant at a high temperature and high concentration effectively removes biofilms from hemodialysis piping. However, long-term exposure to disinfectants may affect the piping material.

Introduction: Inferior vena cava tumor thrombectomy in renal cell carcinoma patients is a challenging procedure, frequently requiring the vascular bypass technique for high-level thrombi with additional complications. Adopting a technique such as intrapericardial control in selected cases will circumvent these problems. Here, we present the results of our intrapericardial control technique during supradiaphragmatic inferior vena caval tumor thrombectomy.Case Presentation: The records of six patients with supradiaphragmatic tumor thrombi, who underwent radical nephrectomy and thrombectomy at our center with intrapericardial control between the years 2008 and 2015, were retrospectively reviewed. The patients’ characteristics, intra- and postoperative data, histology, and follow-up records were gathered and compared. There were no immediate or 30-day postoperative deaths. The mean age of the patients was 61.3 years (range 46 - 75). The total mean duration of surgery was 315 minutes and the mean amount of transfused red blood cells was 4.33 units during surgery and 0.8 units in the postoperative period. The average hospitalization duration was 8 days (range 5 - 17). Tumor stage was T3 in four patients and T4 in two, due to ipsilateral adrenal involvement. The mean duration of follow-up was 33.5 months. Only one of the patients developed recurrences, first in the tumor bed and then at the site of the skin incision; these were excised with no apparent complications.Conclusions: Radical nephrectomy and tumor thrombectomy by intrapericardial control without cardiopulmonary bypass and hypothermic circulatory arrest is a safe and effective procedure that can avoid serious intra- and postoperative complications while providing acceptable cancer-control and mortality results.

Background: Percutaneous nephrolithotomy (PCNL) is recommended for treating staghorn stones or stones measuring>20 mm.Extracorporeal shockwave lithotripsy (ESWL) or flexible ureteroscopy (URS) may be used as a complement. However, PCNL can cause trauma to the kidney parenchyma, and patients may find a noninvasive procedure, such as ESWL, to be more attractive.Objectives: The aim of this study was to evaluate the clinical efficiency of MiniJFil® stenting associated with ESWL or second-line URS for the treatment of medium-to-large kidney stones. The MiniJFilÒ is a stent reduced to a suture of 0.3F attached to a renal pigtail. The entire ureter is occupied only by the suture of the stent.Methods: We retrospectively analyzed the data of 28 patients. Twenty-four patients had kidney stones measuring>15mm (group 1) and four patients had staghorn stones (group 2). All of the patients were fitted with MiniJFilÒ 2 - 3 weeks before any treatment.ESWL was always our first-line therapy. Stone-free (SF) status was defined as no evidence of stones.Results: In group 1, themeanlargest and cumulative stone diameters, respectively, were 18.7±5.7mmand 45.0±12.0mm. In group 2, the mean volume was 6, 288.4±2, 733.0mm3. The overall SF was 96.4% (100% for group 1 and 75% for group 2). The mean number of sessions of ESWL and URS, respectively, was 1.4± 0.7 and 0.8±0.9 in group 1 and 4.0±2.0 and 1.5±1.3 in group 2. The mean times to achieve these rates were 3.2±1.7 months and 5.6±2.3 months for groups 1 and 2, respectively. One patient in group 2 was treated with only three sessions of ESWL. Renal colic was observed in only five patients (17.9%).Conclusions: MiniJFilÒ stenting is safe and may be an alternative for the treatment of kidney stones during minimally invasive procedures.

Background: Anxiety is the most common mental disorder in end-stage renal disease patients. The use of aromatherapy as a treatment for anxiety has increased substantially in most countries.Objectives: This study aimed to investigate the effect of inhaling rose water aromatherapy on anxiety in hemodialysis patients.Methods: This randomized controlled clinical trial was carried out in the hemodialysis ward of Birjand ValiAsr hospital on 46 patients who were randomly divided into control and experimental groups. The standard state-trait anxiety inventory of Spiel berger was used to investigate the anxiety level of the samples. The experimental group inhaled rose water for 4 weeks, but the control group did not undergo any intervention. At the end of week 2 and week 4, the participants’ anxiety was measured, and the results were statistically analyzed.Results: Mean scores of state and trait anxiety in the experimental group before intervention were 47.47±7.6 and 49.56±13.8, respectively; those afterweek4following the intervention were reduced to 37.1±6.5 and 42.9±10.1; inhalation of rose water fragrance in the experimental group caused a significant decrease (P<0.001) in the state and trait anxiety levels compared with controls (P=0.43).Conclusions: According to the present study, rose water noticeably reduces the anxiety of hemodialysis patients. Therefore, inhalation of rose water can improve the patient’s emotional and spiritual condition during hemodialysis treatment.

Background: To assess the effectiveness of the current vesicoureteral reflux (VUR) grading system according to the international classification of VUR (ICVUR) and to evaluate whether VUR grading accuracy could be improved by renal ultrasonography (RU) according to the Society for Fetal Urology (SFU) grading system.Objectives: Therefore, this study assessed the accuracy of the currentVCUGstaging system by assessing inter-rater reliabilityamong pediatric radiologists and urologists; it also evaluated whether accuracy is increased byRUwithout consensus (with respect toVCUG grading).Methods: Four pediatric urologists and four pediatric radiologists independently graded 120 voiding cystourethrograms (VCUGs). Middle VUR grades were divided into the following three groups: VUR consensus grade III (group 1), VUR consensus grade IV (group 3), and VUR non-consensus grades III and IV (group 2). All groups were compared with respect to hydronephrosis grade using RU.Results: The intraclass correlation coefficient (ICC) values ranging from 0.86 to 0.89 reflected good reliability. The lowest agreement was associated with middle grades (III and IV). A marked difference in sensitivity was observed between groups 1 and 3 (35% and 95%, respectively, P<0.05), indexed by SFU hydronephrosis grade, suggesting that VCUG cases in group 2 (n=16 at SFU 0 or 1) could be accepted as grade III, and SFU scores of 2, 3, or 4 could be considered grade IV.Conclusions: Inter-rater accuracy could be improved at middle grades using renal ultrasonography (USG), which could promote communication between different specialists.

Background: Nephrotoxicity is the most clinically significant adverse reaction of amphotericin B. Different aspects of amphotericin B (AmB) nephrotoxicity have not been studied well in our population.Objectives: The purpose of this study was to assess the frequency, time onset, and possible associated factors of AmBnephrotoxicity in hospitalized patients in hematology-oncology wards in the southwest of Iran.Patients and Methods: A cross-sectional, observational study was performed over a period of 9 months at 2 hematology-oncology and 1 hematopoietic stem cell transplantation wards at Namazi Hospital. Patients aged 15 years or older with nodocumented history of acute kidney injury or chronic kidney disease who were scheduled to receive formulations of AmB intravenously for at least 1 week were included. The required demographic and clinical data of the patients were recorded. Urine urea, creatinine, sodium, potassium, and magnesium levels were measured at days 0, 3, 5, 7, 10, and 14 of the AmB treatment. AmB nephrotoxicity based on serum creatinine increase, renal potassium wasting, hypokalemia, and hypomagnesemia were determined.Results: Amongthe40patients recruited for the study, 11 (27.5%) patients developed AmB nephrotoxicity with amean±standard deviation onset of 6.73±2.36 days. In 5 patients, AmB nephrotoxicity resolved spontaneously without any intervention. According to the multivariate logistic regression model, none of the studied demographic, clinical, and paraclinical variables were significantly associated with AmB nephrotoxicity. The duration of hospitalization (P=0.541) and the mortality rate (P=0.723) were comparable between the patients with and without AmB nephrotoxicity. Hypokalemia and renal potassium wasting were identified in 45% and 27.5% of the patients during AmB treatment, respectively.Conclusions: Nearly one-third (27.5%) of our cohort developed nephrotoxicity within the first week of AmB vtreatment. Hypokalemia and renal potassium wasting were more notable, affecting about one-third and one-half of the AmB recipients, respectively.

Background: Phytotherapy is a popular treatment option in cases of benign prostatic hyperplasia (BPH), with many different herbal products being used for the treatment of this condition. Withania coagulans (WC) is an herbal medicine that has shown anti-tumoral, anti-inflammatory, and antioxidant effects.Objectives: This study examined the effect of Withania coagulans extract (WCE) on prostatic cell apoptosis and cyclooxygenase-2 (COX-2) expression in cases of benign prostatic hyperplasia (BPH) in rats.Methods: Forty Wistar rats were equally divided into five groups: control, sham, BPH, BPH+WCE, and BPH+CLX (celecoxib) as a positive control group. The induction of BPH was achieved via the subcutaneous injection of 3 mg/kg of testosterone propionate (TP) daily for 28 days. The animals received WCE, celecoxib, or distilled water by oral gavage accompanied by the TP injection. After four weeks, the prostate glands of the rats were weighed to measure the prostatic index (PI). The ventral lobes of the prostates were dissected and processed with paraffin blocks in order to study the number of mast cells. A TUNEL analysis was performed to evaluate the cell apoptosis, while the expression of COX-2 was examined using immunohistochemistry.Results: BPH was obvious in the ventral lobe of the prostate, and the administration of WCE markedly decreased the PI and the number of mast cells (P<0.001) in the BPH rats. Additionally, the WCE treatment induced prostatic cell apoptosis when compared to the BPH group. Furthermore, following the WCE treatment, the expression of COX-2 in the prostatic tissues was significantly decreased when compared to the BPH groups.Conclusions: According to the results of this study, WCE was effective in the treatment of BPH in rats. It may therefore have beneficial effects in the treatment of patients with BPH.

Background: Spina bifida increases the risk for urinary tract infections (UTI). Antimicrobial prophylaxis (AP) reduces symptomatic UTI’s but selects resistant organisms. Measures to ensure regular and complete emptying of the bladder combined with treatment of constipation reduce the risk for UTI.Objectives: Demonstrate that close adherence to a catheterization regimen in children with spina bifida (Selective Treatment - ST) reduces the need for antimicrobial prophylaxis.Methods: Case series analysis of pediatric spina bifida clinic patients where routine antimicrobial prophylaxis was replaced by clean-catch catheterization and daily bowel regimen (ST). Retrospective chart review of 67 children (mean entry age: 24 months, median age: 4 months; 32 Males, 35 Females) enrolled between 1986 - 2004. Mean follow-up was 128.6 months (range 3 - 257 months).Asymptomatic and symptomatic UTI incidences were noted on AP and ST protocols. Creatinine clearance at study entry and follow up was calculated by the age appropriate method. A multivariable regression model with delta Glomerular Filtration Rate (GFR) as the dependent variable, independent sample t-test and Wilcoxon rank sum were performed with SAS v.9.2.Results: The mean number of infections while on AP was 8.7 (95% CI 5.72, 11.68) and was 1.0 on ST (95% CI 0.48, 1.43).5 infections on the AP protocol required intravenous (IV) antibiotics due to resistance to oral therapy, but none on ST. Comparing change in GFR between both protocols (AP vs. ST) found a significant difference in the change of GFR by treatment protocol.Conclusions: AP did not prevent UTIs and resulted in more resistant organisms requiring IV antibiotics. Discontinuing AP allowed the return of susceptibility to oral antimicrobials and significantly improved GFR in those children who had previously been on AP. Adherence to a catheterization regimen with prompt treatment of symptomatic UTI conserved renal function and prevented selection of resistant organisms.

Background: Chronic kidney disease (CKD) is a major public health problem that may lead to end-stage renal disease (ESRD). Renal transplantation has become the treatment modality of choice for the majority of patients with ESRD. It is therefore necessary to monitor the disease progression of patients who have undergone renal transplantation. In order to monitor the disease progression, the continuous assessment of kidney function over time is considered.Objectives: This study aimed to investigate the etiological role of recipient characteristics in serum creatinine changes within the follow-up period and in relation to the graft failure risk, as well as to evaluate whether or not the serum creatinine level represents an indicator of graft failure following renal transplantation.Methods: This retrospective cohort study was conducted at the department of nephrology, Baqiyatallah Hospital, Baqiyatallah University of Medical Sciences, between April 2005 and December 2008. The study involved 413 renal transplantation patients. The primary outcomes were the determination of the serum creatinine levels at each attendance and the time to graft failure. Robust joint modeling of the longitudinal measurements (serum creatinine level) and time-to-event data (time to graft failure) were used for the analysis in the presence of outliers in the serum creatinine levels. The data analysis was implemented in WinBUGS 1.4.3.Results: There was a positive association between the serum creatinine level and graft failure (HR=5.13, P<0.001). A one unit increase in the serum creatinine level suggests an increased risk of graft failure of up to 5.13 times. The serum creatinine level significantly decreased over time (95% CI: (-1.58, -1.08)). The recipient’s age was negatively associated with the serum creatinine level (95% CI: (-0.02, -0.001)).Conclusions: Graft failure is more likely to occur in patients with higher serum creatinine levels.

Background: Varicocele, one of the most common causes of sperm abnormalities in men, is the dilation of the testicular vein (the pampiniform venous plexus) by more than 2 mm. Ultrasonography is the primary imaging procedure for varicocele diagnosis. The venous diameter is evaluated using B-mode sonography, and venous reflux is assessed using color Doppler sonography.Objectives: In this study, we investigated the association of ultrasound findings with sperm parameters in patients with varicocele.Methods: Ninety-nine patients with clinically diagnosed varicocele were included in this study, which was performed at a university imaging center. Patients were evaluated for pampiniform venous plexus diameter, venous reflux, and testicular size on both sides.Semen analysis was performed for all patients. The ultrasonography parameters and semen analysis data were compared to assess the correlations between the results.Results: The semen analysis parameters, including semen volume and sperm morphology, count, and motility, significant correlations with the diameter of the varicocele vein but were not correlated with testes size. In addition, the patients with reflux of longer than 1 s and those with reflux of less than 1 s had significant differences in sperm parameters and varicocele size.Conclusions: Our study showed that ultrasonography findings can be a good predictor of sperm parameters in patients with varicocele.