JOURNAL OF RENAL INJURY PREVENTION
Year:2019 | Volume:8 | Issue:3|Papers Count:17

Bartter syndrome is an autosomal recessive kidney disorder characterized by hypokalemia, metabolic alkalosis, and normal blood pressure (1). The syndrome is associated with mutations in Na+, K+, 2 Cl-system also called as the Na+-K+-2Cl-cotransporter in the tick ascending loop of Henle (2). ...

Hyperuricemia (defined by serum uric acid levels above 7 mg/dL in men and 5. 5 or 6 mg/ dL in women) is a common finding in patients with chronic kidney disease (CKD). From the early 1800’ s hyperuricemia was recognized as a cause of gouty arthritis. At the same time hyperuricemia was suggested to have an underlying relationship with various cardiac and kidney diseases such as arteriolosclerosis, hypertension, cardiovascular and kidney diseases (1, 2).

Methylenetetrahydrofolate reductase (MTHFR) is involved in the homocysteine metabolism. Two common variants of MTHFR gene (677C>T and 1298A>C), have been reported to reduce the MTHFR enzyme activity and leading to plasma hyperhomocysteinemia. There are a number of recent case-control studies that investigated the association between the MTHFR polymorphism and diabetic nephropathy (DN), albeit with inconsistent results. The aim of this meta-analysis is to evaluate the associations between the genetic polymorphisms of MTHFR with susceptibility to DN. A literature search was conducted on PubMed, Embase and Google scholar from inception till March 18, 2019. For MTHFR 677C>T analysis, a total of 23 studies including DM controls (3095 cases and 3187 DM controls) and 12 studies including non-DM controls (1590 cases and 2052 non-DM controls) were taken. For MTHFR 1298A>C analysis, a total of 7 studies using DM controls (959 cases and 1209 DM controls) and 3 studies using non-DM controls (400 cases and 802 non-DM controls) were taken. Meta-analysis showed that mutant genotypes of the 677C>T (OR: 1. 58; 95%CI: 1. 16-2. 14) and 1298A>C (OR: 1. 38; 95%CI: 1. 16-1. 65) polymorphisms in the MTHFR gene were associated with increased risk of DN (diabetic kidney disease). MTHFR 677C>T and 1298A>C polymorphisms revealed significant heterogeneity between studies. Further, there was no evidence for publication bias for these polymorphisms. In conclusion, this meta-analysis provides strong evidence that MTHFR 677C>T and 1298A>C polymorphisms may be associated with increased risks of DN. However, further studies are still needed to accurately determine whether MTHFR genetic polymorphisms are associated with susceptibility to DN.

Lactic acidosis (LA) secondary to metformin administration is a rare incident with a very high mortality rate (≥ 50%). Hypoxia has been suggested to contribute to metformin-associated lactic acidosis (MALA) in 90% of patients developing this condition. In susceptible patients such as those with renal insufficiency, the level of plasma metformin is increased particularly after exposure to iodinated contrast media (ICM). One major concern in patients with renal insufficiency is to adjust the metformin dose based on the renal functional capacity prior to ICM examination. In this review, we assessed metformin tolerable threshold in diabetic patients with renal failure. We also reviewed metformin withdrawal criteria in patients with chronic kidney disease (CKD) exposed to intravenous ICM during angiography. Our results indicated that in patients with insufficient renal function (i. e. 30< estimated glomerular filtration rate(eGFR) <60 and 30

Diabetes is the most common cause of renal failure which is frequently seen in candidates of solid organ transplant both before and after of the transplantation. For successful long-term tissue graft, it is important to control blood glucose level particularly after transplantation. Post-transplant diabetes mellitus (PTDM) is the main issue contributing to cardiovascularrelated mortality in kidney transplant recipients. Important risk factors of PTDM include using immunosuppressive drugs, post-transplant weight gain and obesity, and the presence of pre-transplant diabetes. Because of safety concerns, there has been a consensus from 2003 onward to cease metformin as the first-line anti-diabetic drug in patients with PTDM. The relationship between PTDM and metformin administration in high-risk renal transplant patients needs to be validated by more trial studies to establish the risk-benefit balance using this drug. Here, we reviewed the pros and cons of using metformin by presenting conclusions from several retrospective and clinical trial studies.

Nitric oxide (NO) has various physiological and biochemical effects. In many biological systems of the body, NO acts as a messenger molecule via cyclic guanosine monophosphate (cGMP), which affects the body cells. NO is synthesized in the body from the L-arginine amino acid by the NO synthases enzyme. This enzyme consists of three major isoforms including neurotransmitter, endothelial and inductive types. According to the results of numerous studies, the administration of ozone as a complementary therapy of the diseases is a less complicated and cost-effective way. Over the past forty years, the results of ozone therapy have been satisfactory and without any problems. Ozone therapy affects various diseases. For example, in treatment for vascular diseases and some degenerative diseases, it has an ameliorative impact. Regarding kidney disease, still many experimental or clinical studies are necessary to find its improvement/anti-oxidative effect.

Introduction: Apolipoprotein L1 (APOL1) gene’ s risk variants located on chromosome 22 are newly discovered factors for the development of chronic renal failure among African-American. These risk alleles were developed on the African continent as an evolutionary defense against sleep sickness due to Trypanosoma brucei rhodesiense and then spread with human migrations. Objectives: In the present study, we sought to examine these risk variants in a group of hemodialysis patients of Northwest of Iran. Patients and Methods: Two hundred patients receiving hemodialysis in different centers of the city (Tabriz in Northwest of Iran) were allocated randomly from a total number of 825 patients. The assessment of APOL1 polymorphisms (rs73885319, rs60910145, and rs71785313) was conducted using polymerase chain reaction– restriction fragment length polymorphism (PCR-RFLP) method. Patients’ demographic data, history, and their biochemical parameters were recorded based on their last measurement. Results: No proposed renal risk variants of APOL1 gene in our hemodialysis population were found. All the participants had a wild genotype. Conclusion: The results of our study match with reports from Europe and Asia. In the paleoanthropological point of view, our results do not support African human migration hypothesis.

Introduction: Lupus nephritis (LN) is one of the most severe signs of systemic lupus erythematosus (SLE) and rapid diagnosis of kidney damage remains an important concern for LN. Objectives: The aim of this study was to investigate the association of the serum levels of tumor necrosis factor-like weak inducer of apoptosis (TWEAK) and interleukin 17 (IL-17) with SLE severity, renal involvement, and other clinical manifestations in lupus patients. Patients and Methods: In order to determine a better biomarker for the detection of renal damage, this study evaluated the ability of serum TWEAK (sTWEAK) and IL-17 in lupus patients with (n = 25) and without (n = 25) nephritis and healthy controls (n = 39). Moreover, it compared the levels of these cytokines with disease activity and chronicity as well as traditional serum markers including complement C3 and C4, creatinine, and proteinuria in lupus patients. Results: Increased levels of sTWEAK and IL-17 were observed in SLE and LN groups compared to healthy controls and non-LN groups, respectively. Significant positive associations were observed between serum TWEAK and IL-17 levels and systemic lupus erythematosus disease activity index (SLEDAI), proteinuria, nephritis activity index, and some clinical manifestations (P < 0. 05). Discriminating the ability of the studied cytokines were not better than the utility of any markers individually. Conclusion: The serum levels of TWEAK and IL-17 in the SLE and LN groups were significantly higher than the control group and both markers were indicative of the renal disease severity; therefore, they could possibly indicate renal involvement in the lupus patients.

Introduction: Urinary stones are one of the most common and painful diseases of humans after urinary tract infections and prostate diseases. Objectives: The aim of this study was comparing the efficacy and complications of combined cystone and hydrochlorothiazide with cystone monotherapy in the treatment of upper urinary stones. Patients and Methods: In this randomized clinical trial 80 patients older than 15 years old with renal and ureteral stones less than 10 mm after taking informed consent form were allocated randomly in one of two groups. Patients with azotemia, hydronephrosis, bothersome pain and pregnant women were excluded. In the first group, combinations of cystone and hydrochlorothiazide tablets (every 12 hours, two 100 mg cystone and 25 mg hydrochlorothiazide) were prescribed. In the second group, cystone were prescribed as the first group. One month later, patients were followed by kidney, ureter, and bladder x-ray (KUB) and ultrasonography and the success of treatment was determined by changing the size of stones and report of stone passage by the patients. All data were collected and analyzed by SPSS software version 23 and statistical tests. Results: The mean age of the patients in combined and single groups were 48. 02± 13. 72 and 44. 15 ± 14. 86 (P = 0. 24) years respectively. The mean size of stone after treatment in two groups was 1. 72± 0. 98 and 1. 85± 0. 78 mm respectively (P = 0. 53). Regarding efficacy of combined and single group, more than 90% of the patients reported stones passage after the intervention (P = 0. 06). There were no significant differences in mean blood urea (P = 0. 38) and serum creatinine (P = 0. 53) after treatment in two groups. Conclusion: The results of this study showed that combination of cystone and hydrochlorothiazide do not increase the efficacy of cystone in treatment and passage of urinary stones, although in both groups stone passage significantly increased. Trial Registration: Registration of this randomized clinical trial has been approved (approval date; 2018-01-10, ) in Iranian registry of clinical trials ( identifier: IRCT20081011001323N15; https: //irct. ir/trial/29499; Ethics committee reference number; IR. YUMS. REC. 1396. 156).

Introduction: Chronic kidney disease (CKD) is a disabling disease with multiple complications, like, increased serum levels of uric acid due to glomerular filtration rate (GFR) impairment. Objectives: This study was designed to evaluate the effect of allopurinol on metabolic acidosis in patients with renal failure. Patients and Methods: This is a randomized controlled-trial study on 50 patients with CKD stage II-IV, who referred to Qaem and Montaserieh hospitals in Mashhad. Patients were selected and randomly divided into two equal groups of 25 subjects. In addition to standard treatments, the intervention group received 100 mg allopurinol tablet for three months and the control group received placebo. Demographic data were obtained from each individual. Serum uric acid level, creatinine, blood pH and bicarbonate levels were assessed at the initiation of treatment and at the end of the third month. Results: The mean age of patients was 54. 04± 12. 62 years. Allopurinol administration resulted in a significant increase of serum bicarbonate levels and pH (P < 0. 001 for each) compared to the control group. A significant reduction in uric acid (P < 0. 05) and an increase in GFR (P < 0. 05) was observed in both groups. Conclusion: Allopurinol could ameliorate metabolic acidosis, glomerular filtration and uric acid in patients with CKD. Trial registration: This study was registered in Iranian Registry of Clinical Trial (identifier: IRCT2016122731604N1; https: //irct. ir/trial/24831; registration date: 2017-08-05).

Introduction: Extracorporeal shock wave lithotripsy (ESWL) is known as the most common method in treating urinary stones (70%) and is a selective method to treat small urinary stones (<2-2. 5 cm). General opinion is that the success rate of ESWL in obese patients is low and risk of complications is high. Objectives: The aim of this study was to evaluate the impact of body mass index (BMI) and the stone-to-skin distance on success, complications and failure of ESWL. Patients and Methods: In this study, 222 patients who referred to lithotripsy clinic of Kashani hospital of Shahrekord to break stones with diameters of 5 to 20 mm participated in the study. Their urinary stones were in kidneys, lower calyces, upper calyces, pelvis or proximal ureter and were divided into two equal groups of BMI >25 kg/m2 and BMI <25 kg/m2. Assessing the position and diameter of the stones was based on radiographic findings such as sonography and CT scan. Regarding success, failure and complications of lithotripsy, two groups were compared. Results: Around 105 and 117 patients out of 222 subjects, were respectively assigned in BMI>25 kg/m2 and BMI <25 kg/m2 groups. The failure and success of both groups were statistically significant (P = 0. 023). In terms of treatment outcomes, difference between two groups was high in low skin-to-stone distance (SSD). Logistic regression showed that both BMI and SSD are effective factors in treating the stone while SSD was more effective (P = 0. 004) than BMI (P = 0. 023) since SSD>7. 5 cm predicts treatment failure. Conclusion: BMI and SSD are effective factors on the outcome of ESWL. Higher BMI and SSD> 7. 5 cm are effective factors on treatment failure.

Introduction: Hyperlipidemia is considered a prominent risk factor for coronary heart disease. Coronary heart disease is the most common cause of mortality and morbidity in chronic kidney disease (CKD) patients. Objectives: The aim of this study was to evaluate the effects of artichoke leaf extract (ALE) supplementation on the lipid profile of CKD patients. Patients and Methods: A randomized, double-blind, placebo-controlled clinical trial was conducted in 38 CKD subjects (GFR<60 and >15 mL/min/1. 73 m2) with hypercholesterolemia (total cholesterol ≥ 200 mg/dL or low-density lipoprotein cholesterol [LDL-C] ≥ 110 mg/dL). The intervention group received an artichoke capsule (320 mg) and an indistinguishable placebo was given to the control group twice daily for 6 weeks. Lipid profile and appetite were assessed at week 8 and the results were compared with the baseline data. Results: ALE supplementation was correlated with a statistically significant decrease in mean total cholesterol (P = 0. 028) and LDL-C (P = 0. 005) compared to the control group. The two groups did not show a significant difference in high-density lipoprotein-cholesterol (P = 0. 071) and triglyceride levels (P = 0. 22). There was a statistically significant difference in appetite between the two groups (P = 0. 016). Conclusion: This randomized controlled trial demonstrated that consumption of ALE supplement may improve appetite and lipid profile in CKD patients. Trial Registration: This RCT has been approved by Iranian Registry of Clinical Trials identifier: IRCT2016021622689N3; http: //en. irct. ir/trial/19516, Ethics committee reference number; Ir. tums. rec. 1394. 1531).

Introduction: Recently, the consequence of chemical industries and noise on human health is the update subject for researchers. There are many reports published about nephrotoxicity of noise and cadmium alone. Objectives: The main aim of this study was to detect the combined consequence of noise and cadmium on renal function. Materials and Methods: Forty adult male rats were put into eight groups in random order (n=5). Groups 1 control, group 2 exposed to 90 dB (decibels) noise, groups 3-5 received (intraperitoneal; ip) cadmium chloride (CdCl2) at doses of 1, 2, 3 mg/kg and group 6-8 pretreated with CdCl2 at doses of 1, 2, and 3 mg/kg 30 minutes before exposing to 90 dB noise. The exercise was repeated for seven consecutive days. Animals were killed 24 hours afterwards. Blood urea nitrogen (BUN) and creatinine (Cr) levels were analyzed. Kidney tissues were excised for measuring malondialdehyde (MDA) and glutathione (GSH) concentrations. Results: There was significant rise on the levels of BUN, Cr and MDA. Additionally, a decrease on the level of GSH in rats that were exposed to noise or cadmium alone or combined to noise and cadmium was detected. Significant elevation of BUN, Cr, MDA and depletion of GSH were also noted in cadmium-treated rats compared to those in the animals co-exposed to cadmium and noise. Conclusion: This study shows that exposed rats to cadmium and/or noise caused renal function impairment. Production of oxidative stress is responsible for cadmium or noise induced nephrotoxicity. However, co-exposure of cadmium and noise reduced nephrotoxicity of cadmium. The possible explanation for noises suppressing cadmium nephrotoxicity is that noise may enhance excretion and/or induced redistribution and depleted accumulation of cadmium in the kidney.

Introduction: Ureteral obstruction by stones is one of the most common urological problems. Objectives: This study aimed to investigate the in vitro effects of hydroalcoholic extract of Peganum harmala L. on the contraction of the human ureter. Materials and Methods: In this study, 28 samples of human ureter tissue were studied. Six tissue samples were examined for the evaluation of P. harmala extract at concentrations of 1, 2, and 4 mg/mL. Moreover, five tissue samples were examined for checking NaCl solution since, six pieces of tissue for the examination of prazosin 10-8M solution. Results: There was a significant difference between the second contraction of P. harmala group with concentration of 4 mg/mL and NaCl group (P<0. 001). Additionally, a significant difference between the prazosin and P. harmala groups with a concentration of 4 mg/mL (P=0. 048) was observed. There is a marginal difference between the secondary contractions in two groups. A significant decrease in secondary contraction (15 minutes after adding the solution) was observed between the prazosin group and the P. harmala group at a concentration of 1 mg/mL (P < 0. 001). Moreover, the secondary contraction of the prazosin group showed a significant decrease compared with the NaCl group (P < 0. 001). Conclusion: Administration of P. harmala extract can be useful in reducing urinary human ureteric contractions while the best effect was achieved at 4 mg/mL of P. harmala extract.

Introduction: Some assumptions have been made on the probable association between fever and pyuria. Objectives: The present study aimed to investigate the association between fever and pyuria. Patients and Methods: In this case-control study, 90 febrile and 90 non-febrile children aged more than one month who were admitted to the pediatric ward were included. Urine specimens of children less than 2 years of age were collected by urine bag. Midstream urine samples were collected and immediately sent to the laboratory for complete urinalysis and urine culture. Results: Overall, 6. 7% in febrile children and 2. 2% in control group had pyuria however there was no significant association between fever and pyuria (P > 0. 05). Additionally, no association between the presence of pyuria and type of disease was detected (P > 0. 40). Conclusion: The present study could not reveal any association between fever and pyuria in children older than one month.

Introduction: Relapses in children with steroid sensitive nephrotic syndrome (SSNS) are common and sometimes triggered by various infections. Low zinc levels have been described in children with nephrotic states. It is supposed to that zinc deficiency might lead to dysregulation of immune system and an increased risk of infection. Objectives: This study sought to examine whether the plasma level of zinc in nephrotic patients is related to the number of relapses in these patients. Patients and Methods: Forty-three children aged 1-10 years were entered in this study. Baseline data including age, serum zinc level, number of relapses during one year was recorded. The t test and chi-square tests were used to compare the mean values and proportions respectively with significant P value (P < 0. 05). Results: Forty-three children with storied sensitive nephrotic syndrome enrolled in this study. Twenty-three (53. 5%) of them were male and 20 (46. 5%) were female. Around 74. 4 % of patients experienced relapses of nephrotic syndrome in one-year period. There was a significant relation between zinc deficiency and recurrence rate. Conclusion: Zinc deficiency is common in children suffering from nephrotic syndrome and is related to recurrence of relapses in these patients.

Introduction: The most important risk factors for type II diabetic patients are poor nutrition, low physical activity, smoking and obesity indicating an inappropriate lifestyle. Objectives: This study aimed to investigate the factors affecting the health promoting lifestyle in type II diabetic patients compared with healthy people. Patients and Methods: The study was descriptive-analytic with two case-control groups carried out on 150 type II diabetic patients and 150 healthy people. Data were collected using demographic characteristics questionnaire and health promoting lifestyle profile II (HPLII). Results: There was a significant difference between the lifestyle of type II diabetic patients and healthy people (P < 0. 001). Additionally, there were significant differences regarding lifestyle dimensions between physical activity, nutrition and stress management in type II diabetic patients compared with healthy people (P < 0. 001). There was no significant difference between the two groups in the dimensions of spiritual growth (P = 0. 074), communication with others (P = 0. 363) and health responsibility (P = 0. 582). Conclusion: This study showed the effective role of lifestyle components in the development of type II diabetes. It is recommended to prevent or manage type II diabetes, through emphasizing on maintaining lifestyle and its dimensions.