JOURNAL OF RENAL INJURY PREVENTION
Year:2016 | Volume:5 | Issue:2|Papers Count:10

Introduction: Recent evidence suggests that preterm birth is a possible risk factor for high blood pressure (BP) in later life. The most widely quoted blood pressure centiles for very low birth weight (VLBW, £1500 g birth weight) infants at corrected term gestation is based on a cohort with mostly late preterm or term infants (Zubrow curves).Objectives: The objective of this study was to determine the clinical utility of the Zubrow curves in diagnosis of hypertension in VLBW infants at their term corrected gestational age (CGA).Patients and Methods: In a case-control study, we compared BP in 75 VLBW infants at 40 weeks CGA (cases) to 69 full term infants admitted to neonatal intensive care unit (NICU) (controls).Results: In spite of having lower weights, VLBW infants compared to term infants (2612.8±546 vs.3308.2±373 g, P£0.001) had higher average systolic (88.8±7.6 vs.82.33±8.5 mm Hg; P£0.001) and mean BP (61.2±6.6 vs.57.61±6.9, P=0.01). Although 41% (31/75) VLBW infants would have met the criteria for hypertension according to Zubrow curves only 4% (3/75) were diagnosed with hypertension.Conclusion: Since Zubrow BP centiles were based on a heterogeneous population of infants including preterm and term infants, new BP centiles based on chronological data from VLBW infants would allow a better definition of hypertension in these infants and identify the threshold BP for initiating treatment.

Introduction: Data regarding prognostic factors of post-discharge mortality and adverse renal function outcome in acute kidney injury (AKI) hospital survivors are scarce and controversial.Objectives: We aimed to identify predictors of post-discharge mortality and adverse renal function outcome in AKI hospital survivors.Patients and Methods: The study group consisted of 84 AKI hospital survivors admitted to the tertiary medical center during 2-year period. Baseline clinical parameters, with renal outcome 3 months after discharge and 6-month mortality were evaluated. According survival and renal function outcome, patients were divided into two groups.Results: Patients who did not recover renal function were statistically significantly older (P<0.007) with higher Charlson comorbidity index (CCI) score (P<0.000) and more likely to have anuria and oliguria (P=0.008) compared to those with recovery. Deceased AKI patients were statistically significantly older (P<0.000), with higher CCI score (P<0.000), greater prevalence of sepsis (P=0.004), higher levels of C-reactive protein (CRP) (P<0.017) and ferritin (P<0.051) and lower concentrations of albumin (P<0.01) compared to survivors. By multivariate analysis, independent predictors of adverse renal outcome were female gender (P=0.033), increasing CCI (P=0.000), presence of pre-existing chronic kidney disease (P=0.000) and diabetes mellitus (P=0.019) as well as acute decompensated heart failure (ADHF) (P=0.032), while protective factor for renal function outcome was higher urine output (P=0.009). Independent predictors of post-discharge mortality were female gender (P=0.04), higher CCI score (P=0.001) and sepsis (P=0.034).Conclusion: Female AKI hospital survivors with increasing burden of comorbidities, diagnosis of sepsis and ADHF seem to be at high-risk for poor post-discharge outcome.

Introduction: Gastroenteritis (GE) is one of the most common pediatric diseases. Hyponatremia commonly occurs by administering hypotonic fluids to GE and hospitalized children. Yet, there is no consensus on the ideal method of treatment.Objectives: we aimed to assess suitable intravenous (IV) fluid for preventing dysnatremia in children with GE.Patients and Methods: This is a double blind randomized clinical trial, which was conducted on infants of 6 months up to 14 years children with GE. Children were randomly assigned in 2 different groups. Group A; received 20 cc/kg 0.9% isotonic saline as a bolus, and 0.45% hypotonic saline as sum of maintenance fluid and volume deficit. Group B was treated with the same bolus and 0.9% isotonic saline with 20 mEq/L KCl as sum of maintenance fluid and volume deficit. Blood and urine samples were taken at admission, 4 and 24 hours. Data were analyzed by independent t test, Mann-Whitney U test, Friedmann test, chi-square and 2-tailed repeated measurements by SPSS version 19.Results: Baseline hyponatremia and isonatremia were detected in 24 (31.5%) and 51 (67.1%) patients, respectively. Mean level of sodium at T0, T4 and T 24 mentioned no significant difference between groups. No hypernatremia was noted by administering isotonic saline. Results showed that 4 and 24 hours after administration isotonic saline, the mean plasma sodium differed significantly in baseline hyponatremic patients. However, no significant difference was noted after 4 and 24 hours in group A.Conclusion: According to the considerable effect of isotonic saline on hyponatremic patients, it seems that administering isotonic fluids regardless of the types of dysnatremia can be recommended to lessen clinicians’ conflicting decision-making in selecting an appropriate fluid.

Introduction: Diabetic nephropathy (DN) is the most common cause of the chronic kidney disease in the world. Oxidative stress on the other hand has a major and well known role in its pathophysiology.Objectives: The aim of the study is to figure out if tempol, a synthetic antioxidant agent, modifies DN and to determine its relevance to changes of serum oxidative biomarkers.Materials and Methods: Twenty-seven male rats were equally divided in to 4 groups (7 rats for each group). Group I (control or C), group II (diabetic or D), groups III (Tempol) which were given tempol (100 mg/kg/day) by gavages for 28 days and group IV (D& T) which includes diabetic rats that also received same dose of tempol. After treatment, blood samples were isolated. Enzymatic scavengers including catalase (CAT), glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities, lipid peroxidation (LPO), total antioxidant capacity (TAC) and total thiol molecules (TTM) were measured. Blood urea nitrogen (BUN), creatinine (Cr) an albumin/Cr ratio were evaluated as well. Statistical differences were assessed with one-way analysis of variance (ANOVA) by SPSS followed by Tukey t test.Results: Oxidative stress biomarkers modified and Alb/Cr ratio increased in diabetic group (II), however, they were altered to normal in group IV (D& T) compared with diabetic group (D).Conclusion: Tempol can modify oxidative stress biomarkers and presumably nephropathy in diabetic rats.

Introduction: Fibroblast growth factor 21 (FGF21) is a metabolic regulator with multiple beneficial effects on glucose and lipid homeostasis and insulin sensitivity.Objectives: The aim of this study was to investigate the relation between the serum level of FGF21 with and metabolic syndrome (MS) in kidney transplant recipients.Patients and Methods: We performed a cross-sectional study on 86 stable renal transplant recipients to detect possible relation between serum FGF21 level and MS during October 2014 and Mach 2015. Patients with past history of diabetes mellitus were excluded.Results: There were 43 patients in each group with and without MS. Totally, they were 52 (60.5%) male and 34 (39.5%) female. The mean age of the MS group was significantly higher than that of non-MS group. There was not significant difference between mean serum creatinine level and glomerular filtration rate (GFR) between two groups (P>0.05). The MS patients had higher weight and body mass index (BMI) (P<0.05). The prevalence of BMI>25 kg/m2 in MS group was 25 (58.8%) versus non-MS group that only 10 (23.3%) had this condition (P<0.05). The mean of FGF21 level in MS and non-MS groups was 1.23±0.67 ng/l and 1.18±0.71 ng/l, respectively (P>0.05). There was not significant difference of serum FGF21 level between MS and non-MS patients (P>0.05).Conclusion: While the elevated serum FGF21 level was found in subjects with insulin resistant states, however, this study revealed that serum FGF21 levels were not significantly increased in renal transplanted recipients with MS as compared with non-MS group.

Introduction: It is known that cytomegalovirus (CMV) infection is a common problem among kidney transplant patients. This infection can be increased morbidity and decreased graft survival. This problem has been associated with acute rejection too.Patients and Methods: One hundred and thirty renal transplant patients were included in a prospective, case-control study. The renal transplant patients were divided into two groups; patients group with CMV infection and control group without CMV infection. Serum CMV-IgG in all patients was positive (donor and recipients). None of patients had received anti-thymocyte-globulin and thymoglobulin. CMV infection was diagnosed by quantitative CMV-PCR (polymerase chain reaction) test (more than 500 copies/μg). Rejection episode was defined by kidney isotope scan or biopsy.Results: In the group of 66 CMV infection patients (41 male [62.1%] and 25 female [37.9%]) the incidence of graft rejection was 36%, however in the group of 64 control patients the incidence of graft rejection was 9.4% (P<0.005).Conclusion: CMV infection is important predisposing factor for acute allograft rejection after kidney transplantation. The results of this study suggests that the control of CMV infection could decrease episodes of acute kidney rejection.

Introduction: The restless leg syndrome (RLS) is a neurologic disorder suffering the hemodialysis patients. Although the pathophysiology of this syndrome remains unknown yet, an investigation of the parameters pertinent to it may help to develop the related medical knowledge and to improve the therapeutic-care interventions in this regard.Objectives: The correlation between the RLSs on individual, clinical, and laboratory indices in patients undergoing hemodialysis.Patients and Methods: This descriptive-analytic study was conducted on 104 hemodialysis patients. Diagnosis of RLS was made using the International RLS Standard Questionnaire. The data on individual, clinical, and laboratory indices were obtained from patients’ recorded files and interviews.Results: Based on our findings, 28.8% of the patients undergoing hemodialysis were affected with mild RLS, 41.7% with moderate RLS, and 29.5% with severe RLS. There was a statistically significant correlation between affliction with RLS on the one hand, and age and gender, on the other (P<0.05). However, there was no significant correlation between RLS and education level, occupation, length of hemodialysis, fasting blood sugar (FBS), hepatitis B and C, serum blood urea nitrogen (BUN), creatinine (Cr), iron, hemoglobin (Hb) level and also KT/Vor URR (P<0.05).Conclusion: Regarding the high prevalence of RLS among the hemodialysis patients, there is the necessity for taking more care of these patients to reduce the somatic complications of the RLS especially among the elderly and female patients and to control the blood sugar of these patients at the normal level.

Introduction: Cardiovascular events are the major cause of death in patients with chronic renal failure. About half of dialysis patients because of reduced phosphorus clearance have hyperphosphatemia. Hyperphosphatemia and following secondary hyperparathyroidism lead to some cardiovascular changes. Hemodialysis (HD) partly removes phosphorus during each dialysis session.Objectives: Presented study was designed to evaluate dialyzer variation effect on phosphorus level as a prognostic factor after dialysis using.Materials and Methods: Six kinds of dialyzer were used for dialysis; low flux (LF) dialyzer (F7 and F8), high flux (HF) dialyzer (F70 and F80) and finally hollow-fiber dialyzers including polyethersulfone (PES) 130 HF and polysulfone (PS) 13 LF. Fifty-seven patients were divided into 6 matched groups included three groups of 10 people and 3 groups of 9 persons in groups: A (F70), B (F80), C (F7), D (F8), E (PES 130 HF) and F (PS 13 LF). Patients were treated for one month with these dialyzers. At the end of the month, blood samples were taken again for phosphorus level before dialysis handling.Results: The mean pre-dialysis serum phosphorus was 5.03, 5.4, 5.2, 4.6, 4.95 and 5.1 mg/dl and the mean phosphorus was 5.43, 5.01, 4.9, 4.18, 4.17 and 5.3 mg/dl after one month of dialysis, respectively in groups A to F without any statistically differences between pre- and after one month dialysis values respectively.Discussion: The findings indicate dialyzer type in the control of serum phosphorus has not been effective in the short-term HD. We suggest a study with more duration time.

Introduction: Graft function early after kidney transplantation is an important parameter in determining the outcome of operation. Urinary and plasma neutrophil gelatinase-associated lipocalin (NGAL), a member of the lipocalin protein family, has been advocated as a sensitive, early biomarker for predicting early renal graft after transplantation. The functions of NGAL appears to be expressed in stress conditions and in tissues undergoing involution. It rapidly accumulates in the kidney tubules and urine after nephrotoxic and ischemic insults.Objectives: This study aimed to examine the prognostic role of NGAL early after renal transplantation.Patients and Methods: A total of 37 kidney recipients were enrolled from a teaching centre in Tabriz within a 6-month period of time. Plasma NGAL was measured immediately before and at 6 and 12 hours post-transplantation. Changes of serum creatinine were documented daily within the first week post-operation. Acute kidney injury (AKI) /graft rejection during the first week after transplantation was the outcome variable.Results: There were 22 males (59.5%) and 15 females (40.5%) with the mean age of 34.93 ± 14.97 years (range: 12-59) in the study group. AKI/graft rejection developed in 12 patients (32.4%). The mean post-transplantation plasma NGAL levels and serum creatinine at all time points were significantly higher in patients with AKI/graft rejection. The best prognostic role was found for plasma NGAL at 12 hours (sensitivity=100%, specificity=92%; cut-off value=309 ng/ml), far better than the prognostic accuracy of corresponding serum creatinine (sensitivity=66.7%, specificity=61.9%).Conclusion: Plasma NGAL, particularly 12 hours after transplantation, is a very sensitive and specific biomarker for predicting acute renal injury.

Introduction: Fibroblast growth factor-23 (FGF23) is found as a bone derived hormone which can influence the serum levels of parathormone, phosphorous and 1, 25-dihydroxyvitamin D. FGF23 may be a cardiovascular biomarker in patients with chronic kidney disease (CKD). While, FGF23 is inversely correlated with serum adiponectin level, thus it is possible that FGF23 is correlated to fat mass and related to dyslipidemia in CKD.Objectives: In this investigation, we studied the association of serum levels of FGF23 with serum lipid profile, body mass index (BMI), and various cardiovascular risk factors in patients with CKD.Patients and Methods: This is a cross-sectional study, which was conducted on 80 non-dialysis patients (glomerular filtration rate [GFR]<60 cc/min) with CKD. Laboratory results and demographic information recorded in pre-defined data sheets and their relationship with FGF23 were analyzed.Results: Eighty patients were studied. Mean±standard deviation (SD) of serum creatinine and FGF23 were 2.18±0.73 mg/dl and 15.028±20.20 RU/ml respectively. The correlation between FGF23, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), ApoA, ApoB, intact parathyroid hormone (iPTH), calcium, phosphorous, alkaline phosphatase, 25-hydroxyvitamin D, BMI, waist girth, serum triglyceride and cholesterol was not significant (P>0.05). In this study, the correlations of FGF23, with serum albumin (P=0.036) and systolic blood pressure (P=0.001) were significant.Conclusion: Our study showed that there are not any significant correlations among FGF23, BMI and lipid profile. There are not any significant correlations between FGF23 and age, sex, and level of calcium, phosphorous, vitamin D. However, the relationships between FGF23 and serum albumin was negatively significant. Additionally we detected a positive significant correlation of FGF23 with level of systolic blood presure.