JOURNAL OF RENAL INJURY PREVENTION
Year:2018 | Volume:7 | Issue:2|Papers Count:12

IgA nephropathy (IgAN) is the most common glomerulopathy worldwide with divergent incidence and prevalence rates,chiefly reflecting different biopsy practices in different parts of the world.It is a heterogeneous disease with respect to clinical and pathological features and the ultimate outcome.This heterogeneity has defied all the attempts to develop a consensus classification,optimize its management and foretell its prognostication,till recent past (1).A concerted effort over 5-year period by a working group comprising of world-renowned nephrologists (from International IgAN Network) and nephropathologists (from Renal Pathology Society) with special interest in the disease led to the promulgation of the Oxford classification of IgAN in 2009 (2,3). ...

Implication for health policy/practice/research/medical education: Kidney is a primary organ for excretion of endogenous and exogenous chemicals. Therefore, all toxic chemicals which are eliminated via urine pass through this organ. It also contains xenobiotics metabolizing enzymes, capable of metabolizing toxic xenobiotics. Increasing evidence supports the view that generation of oxidative stress in situ at least in part is responsible for renal failure. In animal models administration of various antioxidants protected kidney against environmental toxic chemicals. However, further studies are needed for the clinical benefit of antioxidants intervention in renal diseases. Please cite this paper as: Mohammadi A, Ahmadizadeh M. Effects of antioxidants on xenobiotics-induced nephrotoxicity. J Renal Inj Prev. 2018; 7(2): 56-57. DOI: 10. 15171/jrip. 2018. 14.

In 2005, we described for the first time, the syndrome of late onset renal failure from angiotensin blockade (LORFFAB). This is accelerated loss of kidney function in patients on a priori stable doses of an angiotensin converting enzyme inhibitor and/or an angiotensin receptor blocker (ARB), for more than 3 months, with this acute kidney injury (AKI) occurring in the absence of any identifiable known precipitating factors. Moreover, in 2010, we described the syndrome of rapid onset end-stage renal disease (SORO-ESRD). This is acute yet irreversible renal failure following medical illness or surgical procedures, again sometimes in association with concurrent angiotensin blockade. In this article, we describe two representative case reports, one case for LORFFAB and another case for SORO-ESRD and subsequently discuss the implications of LORFFAB and SORO-ESRD in current nephrology practice paradigms. Whereas we support the consensus that angiotensin blockade, for now, remains the mainstay of renoprotection, we however must draw attention to the potential for nephrotoxicity from angiotensin blockade under certain clinical scenarios including the ones described here and more. The association of LORFFAB and SORO-ESRD demands further investigation.

Despite recent improvements in technology of dialysis machine and updated treatment protocols, hemodialysis patients suffer from a high rate of morbidity and mortality. In dialysis centers, healthcare staffs should attempt to provide reliable and efficient care in accordance with clinical guidelines. Integrating intelligent information systems in hemodialysis process have substantially reduced the medical errors rate and improved the quality and efficiency of healthcare through utilize of clinical practice guidelines and of patient information. In this review, we summarize the most important applications of intelligent information systems in hemodialysis adequacy promotion.

Introduction: The salt diet during the pregnancy may disturb the adult offspring’ s organs functions. Objectives: This study was designed to determine the role of high salt intake during pregnancy on the outcome of renal ischemia reperfusion (IR) in adult offspring. Materials and Methods: Renal IR was induced in 55 adult male and female offspring from mothers who intake high salt or normal drinking water during pregnancy, and the kidney function was evaluated. Results: Salt intake during pregnancy increased the serum levels of creatinine (Cr) and blood urea nitrogen (BUN) and decreased creatinine clearances (ClCr) level in offspring after renal IR gender dependently. Conclusion: The structural change in kidney of offspring from mothers who were subjected to salt intake during pregnancy may influence the outcomes of offspring’ s kidney functions after renal IR.

Introduction: The nephrotoxicity of gentamicin is thought to be a dangerous side effect in the use of this drug caused by the formation of oxidative stress and the production of reactive oxygen species (ROS) and nitrogen species. Antioxidant agents play important roles in reducing oxidative stress. Objectives: In this study, the antioxidant role of ferulic acid has been studied in nephrotoxicity caused by gentamicin. Materials and Methods: In this experimental study, 50 Spraque-Dawley rats were randomly divided into 5 groups. The first group was considered as the control group and other groups received different doses of ferulic acid + 80 mg/kg gentamycin for 8 days by intraperitoneally injection. After the treatment, blood samples were prepared from animals. Then, the right and left kidneys were removed, paraffin blocks prepared, and the rest of the tissues were lysed. Three samples were used to evaluate serum creatinine and urea, as well as urine creatinine, histopathologic status and oxidative stress factors levels, respectively. To compare the results of different groups, Mann-Whitney U test was used. Results: Ferulic acid treatment decreased tissue malondialdehyde (MDA), serum urea and creatinine, urine albumin/creatinine ratio and neutrophil gelatinase-associated lipocalin (NGAL), and also increased superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT). Ferulic acid reduced tubular necrosis and eosinophilic casts in gentamycin group induced nephrotoxicity. Conclusion: Ferulic acid can be effective in inhibiting gentamicin-induced nephrotoxicity.

Introduction: The role of vitamin D in kidney stone disease and its effect on stone formation is still controversial. Objectives: To find out the possible role of 25(OH) D3 as an intrinsic factor in urinary calcium stone formers (SFs; individuals with one episode during the last 5 years and individuals with more than one episode during the last 5 years), we investigated the effect of serum levels of vitamin D on recurrence of urinary stones in SFs and control subjects (non-SFs). Patients and Methods: A total of 30 patients with first episode of urolithiasis (group A) and 30 patients with more than one episode of urolithiasis during the last 5 years (group B) aged 18 or older enrolled in this study and underwent metabolic evaluation including the measurement of serum level of 25(OH)D3, parathyroid hormone (PTH), calcium and uric acid. Thirty age and sex-matched patients who had never urinary stone episode (non-SFs) were considered as control group. The patients in this study were selected among those admitted in Urology Department of Kashani hospital during the last year. Individuals excluded from the study were subjects with hyperparathyroidism or with the previous history of hyperparathyroidism. Results: Mean level of 25(OH) D3 was positively correlated with recurrent stone (mean 19. 89 ± 7. 6 in the control group versus 47. 21 ± 19. 77 in the group with the recurrent stone disease). The recurrent stone group (SFs) had the higher serum level of 25(OH) D3 than the control. No correlation was observed between the serum levels of PTH and 25(OH) D3 (r = 0. 13, P = 0. 11) in both control and urinary SFs group. Conclusion: High serum level of vitamin D has an important effect on the pathogenesis of repeated urolithiasis. High serum levels of 25(OH) D3 were detected in the group with recurrent kidney stone disease. But it seems there was no relation between serum level of vitamin D3 and one episode of urolithiasis. Based on the results of this study, the high level of vitamin D3 may have a significant role in inducing the recurrence of urinary stone.

Introduction: Meatal stenosis is a late complication of circumcision. Objectives: This study was designed to determine its prevalence, its relationship with age of circumcision and its applied method. Material and Methods: This prospective study was conducted between December 2006 and January 2012. A total of 2389 boys, equal to or less than 6 years were circumcised using the Plastibell device (PD) or conventional dissection surgery (CDS). They followed up 12 months after surgery. Signs and symptoms of meatal stenosis recorded and the meatus evaluated for stenosis. Results: Meatal stenosis was diagnosed in 41 boys (1. 7%). Twenty-five of patients were asymptomatic (61%). The difference between the mean age of circumcision in patients with meatal stenosis and the others were statistically significant. In newborns the prevalence of meatal stenosis was more than the other ages (15% versus 1. 4%, P < 0. 01). Concerning the method of circumcision, a significant difference on the prevalence of meatal stenosis was detected too (0. 8% in PD versus 3. 6% in CDS; P < 0. 001). The mean interval between circumcision and diagnosis of meatal stenosis was 9. 59 months. Conclusion: Symptomatic presentation of meatal stenosis may be late and it needs long-term follow-up. Its prevalence is higher in younger boys. Thus, circumcision in younger boys, especially in neonates is not recommended. Using PD has lower rate of meatal stenosis in comparison to CDS. Hence, the result of this study showed, the PD is preferable in younger boys.

Introduction: Dextranomer/hyaluronic (Dx/HA) acid is the only tissue-augmenting agent approved by the Food and Drug Administration (FDA) for the vesicoureteral reflux (VUR) treatment. Objectives: We aimed to evaluate short-term outcomes of the Dx/HA in patients who had undergone subureteric injection. Patients and Methods: In this study, 30 patients with VUR diagnosis who had indications for open surgery were enrolled in the study. Patients underwent subureteric Dx/HA injection. Additionally patients underwent a one-year follow up period, subsequently. Follow up included urine analysis, urine cultures and kidney and urinary tract ultrasonography study. Results: Of a total 30 patients, 8 patients (27%) were male and 22 patients (73%) were female. The mean age of patients was 25. 19 ± 0. 70 months. Postoperative VUR resolution was observed in 28 patients (93. 3%). Moreover, during one year follow up, urinary tract infection (UTI) was not reported in patients. However, recurrent VUR was detected in 8 patients (27%) during ultrasonography follow up. Analysis showed no significant difference of recurrence in VUR between males and females (P = 0. 285) and VUR severity (P = 0. 1). There was a significant relationship between recurrent UTI history before intervention and VUR recurrence after subureteric injection (P = 0. 007). Conclusion: Dx/HA acid subureteric injection provides acceptable resolution rate among VUR patients, but its biodegradability causes VUR recurrence during one-year follow up.

Introduction: Contrast-induced acute kidney injury (CI-AKI) is one of the common causes of acute kidney injury. Various studies have been conducted to reduce the risk of CI-AKI. Objectives: In this study, we examined the effectiveness of lovastatin in preventing CI-AKI in patients who required iodinated contrast injection. Patients and Methods: This double-blind clinical trial was conducted on 122 patients scheduled for coronary angiography, abdominal computed tomography (CT) scan, and pulmonary CT angiography. Patients were randomly divided into two groups of receiving lovastatin and placebo. Estimated glomerular filtration rate (eGFR) at baseline and 48 hours after iodinated contrast injection was calculated. Results: The incidence of CI-AKI in all study population was 3. 3% (1. 6% in lovastatin group, and 5% in placebo group; P = 0. 309). A significant difference in the mean changes of eGFR (the differences in the mean of eGFR at the 48 hours after iodinated contrast injection versus baseline) between placebo and lovastatin group was observed (P < 0. 001). This finding showed that, after intervention a further decline in the mean of eGFR in the placebo group than the lovastatin group was happened. Conclusion: After iodinated contrast agent administration, in the lovastatin group mean change eGFR was significantly less than the placebo group. This finding indicated that high-dose short-term lovastatin treatment may be effective on CI-AKI prevention.

Hyponatremia, the most common electrolyte abnormality in hospitalized patients, is associated with increased morbidity and mortality. Phase 3 clinical trials and subsequent studies including the Study of Ascending Levels of Tolvaptan in Hyponatremia 1 and 2 (SALT 1 and 2) clearly demonstrated the efficacy of vasopressin antagonists in increasing plasma sodium levels. The “ vaptans” , oral tolvaptan and intravenous conivaptan, are vasopressin antagonists but as recently as 2015, there remained conflicting recommendations for their use by different expert committees in patients with hyponatremia. This circumstance was blamed on limited patient experiences and limited research data. We recently encountered worsening life-threatening symptomatic hyponatremia, unresponsive to hypertonic 3% saline infusion, and impending respiratory failure in a 62-year old obese Caucasian male patient who was further complicated by advanced chronic obstructive pulmonary disease (COPD), pulmonary hypertension and acutely decompensating diastolic heart failure, albeit with stable CKD II creatinine levels. Intravenous loop diuretics may have helped with heart failure but potentially would have aggravated the already critically low sodium levels. He demonstrated a brisk response to intravenous conivaptan administration. Intravenous conivaptan is sine qua non the absolute ideal therapeutic agent for acutely decompensating congestive heart failure with concurrent life-threatening hyponatremia.

Post-transplant glomerular diseases (PTGN) have been documented frequently, although majority of them, are recurrences of primary diseases. In some cases, de novo glomerular diseases can develop in recipients. In this paper, a case of de novo minimal change disease (MCD) after non-related live donor kidney transplantation in a patient with a history of biopsy proven membranous nephropathy is described. A 25-year-old man with history of biopsy-proven idiopathic membranous glomerulopathy (MGN) who had been transplanted 3 weeks before referred to hospital, presented with peripheral edema and massive proteinuria. First kidney biopsy was compatible with acute cellular rejection with glomerulitis. The patient was treated with methylprednisolone. Panel reactive antibody (PRA) and C4d were negative. Anti-phospholipase A2 receptor (PLA2R) antibody was also negative. Another allograft biopsy was conducted and the result was highly suggestive of MCD. Thus final diagnosis was de novo MCD and proteinuria decreased successfully.