Prevalence and predisposing factors of chronic kidney disease in Yazd city; a population-based study

Introduction: Chronic kidney disease (CKD) is a major health problem and one of the public health threats with an increasing prevalence and burden. However, early diagnosis of this disease is challenging in Iran due to insufficient information. Objectives: In the present study, we aimed to determine the prevalence of CKD and its predisposing factors in Yazd city, Iran. Patients and Methods: We conducted this cross-sectional study using the recruitment phase data of Yazd Health Study (YaHS) collected during 2013-2014. Data of 3649 individuals, age 20-69 years were analyzed. Glomerular filtration rate (GFR) was calculated using the modification of diet in renal disease (MDRD) formula and values less than 60 mL/min/1.73 m2 were defined as CKD. Logistic regression was employed to determine the risk factors of CKD. Results: The mean age of participants was 46.0 ± 13.8 years and the overall prevalence of CKD was 6.6 percent (7.6% for women and 5.4% for men). The disease prevalence was 21.5% in the age group of 60-69 years. The prevalence of CKD had a significant relationship with older age, obesity, female gender, diabetes, high blood pressure and history of heart disease. Conclusion: CKD has a high prevalence in the population of this region of Iran. The most important modifiable risk factors for CKD included diabetes and high blood pressure. Therefore, the health system should strive for early detection of CKD in order to prevent morbidity and mortality of this disease.

Sodium-glucose co-transporter 2 inhibitors (SGLT2i); as a preventive factor of kidney failure in patients with type 2 diabetes; a meta-analysis of randomized controlled trials

Introduction: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are a new class of anti-diabetic drugs. SGLT2 inhibitors lower blood glucose levels by decreasing glucose reabsorption in the proximal renal tubule, resulting in increased urinary glucose and sodium excretion. Objective: This study was conducted to investigate the effects of SGLT2i on individual renal outcomes in diabetic patients. Methods: This study was a systematic review and meta-analysis of clinical trials. A comprehensive search of Cochrane Central Register of Controlled Trials was conducted in the Cochrane Library and PubMed, to identify relevant articles focusing on SGLT2i and chronic kidney disease (CKD) in diabetic patients. The most recent article search was conducted on July 12, 2021. Results: Seven randomized controlled trials (RCTs) were included in the meta-analysis. Two trials were comparing dapagliflozin, two comparing empagliflozin, one comparing ertugliflozin, one comparing canagliflozin, and one comparing sotagliflozin. Composite renal outcome and acute kidney injury (AKI) was found in seven and four studies, respectively. Data on end-stage kidney disease (ESKD) and albuminuria or initiation of renal replacement therapy were reported in the two studies. The pooled risk ratio (RR) 95% confidence interval (CI) for the composite renal outcome was 0.54 (0.50–0.59), with 92 % heterogeneity. The pooled RR for AKI was 0.77 (0.66–0.89), with no heterogeneity. A significant lower incidence of albuminuria (RR: 0.69; 95% CI: 0.59–0.81), initiation of renal replacement therapy (RR: 0.71; 95% CI: 0.58–0.87), was observed following the use of SGLT2 inhibitors. Conclusion: Our findings confirm that the SGLT2 inhibitors can reduce the risk of albuminuria, AKI and renal replacement therapy in ESKD patients with T2D (type 2 diabetes). These meta-analyses provide substantial evidence supporting the beneficial effect of SGLT2 inhibitors on reducing CKD events in individuals with T2D.

Evaluation the performance of serum neutrophil gelatinase associated lipocalin as a biomarker of allograft dysfunction in kidney recipients from living donors

Introduction: Serum neutrophil gelatinase-associated lipocalin (sNGAL) has been proposed as an early biomarker for the prediction of delayed graft function (DGF) from cadaveric donors. Objectives: The purposes of this investigation were to explore the time-based trend for sNGAL in kidney recipients from living donors and to evaluate its correlation with graft function recovery during a one-year follow-up. Patients and Methods: Kidney recipients (n=39) were consecutively enrolled. Sample collection was performed before transplantation and at 2, 16, 24, 36, 48 hours after surgery. Kidney recipients were split into immediate graft function (IGF) and DGF based on estimated glomerular filtration rate (eGFR) on day 5 post-surgery. eGFRs >60 mL/min/1.73 m2 on day 5 post-transplantation were considered as IGF. sNGAL was assessed by ELISA. Serum creatinine (sCr) was measured by the Jaffe method. Results: Rates of participants with IGF or DGF were 25 and 14, respectively. Pre-surgery, sNGAL levels in the DGF subset were 21% higher than that of the IGF group. At 2-hours checkpoint, area under curve, sensitivity, specificity and cut-off (ng/mL) for sNGAL were 0.73, 100%, 52% and 151.8. sNGAL levels correlated with allograft function at 6, 9 and 12 months post-transplantation (r=0.66; P=0.007; r=0.836; P=0.031 and r=0.93; P=0.016). Conclusion: We have uncovered that monitoring sNGAL in kidney recipients is a useful biomarker for the evaluation of short- and long postoperative outcome in renal transplant patients from living donors. However, multicenter study with large samples-size is required to ascertain the usefulness of sNGAL as diagnostic tool for the evaluation of allograft dysfunction in renal transplant patients from living donors.

Clinical and laboratory differences between extended-spectrum β-lactamase-positive and extended-spectrum β-lactamase-negative bacteria in febrile urinary tract infection in pediatrics

Introduction: The prevalence of urinary tract infections (UTIs) due to extended-spectrum beta-lactamase (ESBL)-producing bacteria is rising, which needs more potent antibiotics, such as carbapenems. Objectives: To evaluate the clinical and laboratory differences between ESBL-positive and ESBL-negative bacteria in febrile UTI in children between one month to seven years to indicate prognostic parameters for ESBL+ UTI and to suggest appropriate antibiotic treatment. Patients and Methods: This cross-sectional study investigated 282 patients diagnosed with the first febrile UTI. The participants were assigned to ESBL-positive and ESBL-negative UTI groups. The groups were compared based on their clinical and laboratory characteristics and outcomes; the infant group was assessed separately (with the onset age of <3 months). Results: The ESBL UTI was detected in 10.2% of the cases with a history of more frequent hospitalization (P=0.002), longer hospitalization (P=0.04), higher recurrence rate (P=0.003), and more red blood cell count in urine analysis findings (P=0.02). In the antimicrobial susceptibility assay, the ESBL-positive UTI group indicated resistance to third-generation cephalosporins; nevertheless, 93.1% of the cases responded clinically. The infant group showed 13% of the patients with ESBL-positive UTI that was correlated with a history of longer preonset hospital stay (P=0.001), elevated C-reactive protein (CRP) concentration (P=0.002), and elevated recurrence rate (P=0.03), compared to the older group. Conclusion: The ESBL UTI should be further considered due to the resulted recurrence rate. The antimicrobial sensitivity assay indicated resistance to third-generation cephalosporins; however, these drugs are applied as the first choice due to the high response rate. Aminoglycosides are applicable as second choice drugs prior to initiating the use of carbapenems, if third-generation cephalosporins did not indicate bactericidal impacts on ESBL UTI.

The effects of hydroalcoholic extracts of watermelon and Persian melon rind on kidney stone prevention in male Wistar rats: Alternative medicine and the role of physician and nurse

Introduction: Both watermelon and Persian melon extracts have various pharmacological properties like anti-diabetic, anti-viral, anti-cancer, and anti-urolithiasis effects. Objectives: The present study was conducted to investigate the effects of hydroalcoholic extracts of watermelon and Persian melon rind on kidney stone prevention in male Wistar rats. Materials and Methods: Fifty-six Wister rats were randomly divided into seven groups and treated for 28 days. The first group (healthy control) and the second group (negative control) received drinking water and water containing 1% ethylene glycol, respectively. The third and fourth groups, received 100 mg/kg/d hydroalcoholic extract of watermelon rind and Persian melon rind, respectively in addition to 1% ethylene glycol. The fifth and sixth groups, received 400 mg/kg/d hydroalcoholic extract of watermelon rind and Persian melon rind, respectively in addition to 1% ethylene glycol. The seventh group received 0.5 mEq/kg/d potassium citrate in addition to 1% ethylene glycol for prevention and treatment of kidney stone. A 24-hour urine collection was conducted to determine the levels of sodium, calcium, uric acid, oxalate and citrate concentration. Histological study of calcium oxalate crystals was also performed. The serum levels of urea, creatinine, uric acid, calcium, phosphorus, magnesium, SGPT (serum glutamic-pyruvic transaminase), SGOT (serum glutamic-oxaloacetic transaminase), total antioxidant capacity, and malondialdehyde (MDA) of blood were determined accordingly. Results: In the present study, administration of high-dose extract of watermelon and Persian melon rind (400 mg/kg/d) and potassium citrate showed significant changes in variables of sodium, calcium, uric acid, citrate, urine volume (P<0.01), blood creatinine, blood uric acid, blood calcium, and serum SGPT (P<0.05). The histological study of calcium oxalate crystals showed a significant reduction in oxalate levels in all prevention groups. Conclusion: The extracts of watermelon and Persian melon rind are effective in preventing calcium oxalate stones by decreasing the levels of oxalate, sodium, and calcium and increasing citrate levels and urine volume and affecting the total antioxidant capacity. Persian melon rind extract was more effective than potassium citrate and watermelon rind extract in reducing urine sodium. High-dose watermelon rind extract showed similar effects as potassium citrate.

Methicillin-resistant Staphylococcus aureus in urinary tract infections; prevalence and antimicrobial resistance

Introduction: The newly-launched strain of the Staphylococcus aureus, methicillin-resistant S. aureus, is considered the most emerging bacterium in-hospital infections globally. Objectives: The current research focused on the prevalence and virulence features of methicillin-resistant S. aureus (MRSA) bacteria recovered from urinary tract infections (UTIs) cases. Patients and Methods: A total of 710 urine specimens were taken from hospitalized patients who suffered from UTIs. S. aureus was recovered from urine specimens using the microbial culture. S. aureus antimicrobial susceptibility was assessed toward oxacillin and cefoxitin antimicrobial disk to determine the MRSA strains. The polymerase chain reaction (PCR) assessed the distribution of antimicrobial resistance encoding genes. S. aureus antimicrobial resistance was evaluated by disk diffusion. Results: Fifty-five out of 710 (7.7%) urine specimens were positive for the MRSA bacteria. The uppermost antibiotic resistance was obtained against penicillin (100%), ceftaroline (100%), gentamicin (87.2%), erythromycin (76.3%), and ciprofloxacin (69.0%). BlaZ (100%) and tetK (85.4%) had the higher frequency amid examined antimicrobial resistance-encoding genes. Conclusion: The high prevalence of MRSA isolates harboring antimicrobial resistance-encoding genes in the UTIs suggests that diseases caused by them need more expansion healthcare monitoring with essential demand for novel antimicrobials.

Investigating the consequence of chronic exposure to radiation on renal biomarkers among selected radiologic technologists

Introduction: Chronic radiation exposure, particularly among technicians using medical imaging instruments, may contribute to chronic disease, including renal dysfunction. Investigating the potential association of this exposure with biochemical changes may assist disease detection and prevention. Objectives: The study explores the risk of renal dysfunction among radiologic technologists (RTs) with ten years or more of diagnostic imaging experience to evaluate the association of accumulated radiation doses and possible renal injury. Patients and Methods: A retrospective analysis was performed on the effective accumulative radiation dose from 2009 to 2019 among RTs of radiological department at a general hospital in southern Saudi Arabia. Blood samples were collected, and key biomarkers analyzed using a fully automated biochemical analyzer. Serum levels of the following were measured; sodium, gamma-glutamyl transferase (GGT), chloride, creatine kinase (CK), calcium, albumin, urea, creatinine, lactate dehydrogenase, total protein and potassium. In statistical analysis, P<0.05 was considered significant. Results: Even with exposure to only low-level radiation sources, RTs were statistically predisposed to variation in biochemical profiles. RTs exhibited GGT and CK levels higher than that of controls, while serum chloride was significantly low. Conclusion: The current study found a significant change in renal biochemical profiles among RTs who had worked in a radiological department for more than ten years. The association between GGT, CK with Kidney diseases was reported in several reports. Chronic exposure to radiation may contribute to a rise in GGT and CK levels and reduction of chloride and thus could develop the risk of renal diseases.

Ultrasonographic percutaneous nephrolithotomy, with or without ureteral catheter

Introduction: Access by ultrasonography rather than fluoroscopy in addition to reducing radiation exposure to the patient and staff, is safe and effective. Access by ultrasonography is bi-planar and real-time compared to fluoroscopy, because it provides fewer side effects and more stone free rate. Objectives: To study the complications and outcome of PCNL (percutaneous nephrolithotomy) with or without using ureteral catheter. Patients and Methods: We studied 59 patients with at least 2 cm diameter of renal stone from January to December of 2018. After general anesthesia, 35 patients in the ureteral stent group were prepared in bladder lithotomy position. Then 5-French (Fr) ureteral catheters were introduced endoscopically in stone affected side and fixed to 16 Fr urethral Foley catheters in the patients. Other 24 patients in the non-stent group following anesthesia were directed to prone position instantly. In all of the patients, ultrasonography was performed in posterior auxiliary line below the ribs in prone position. Retrograde instillation of normal saline was performed through ureteral catheter in stent-group. Then we inserted 18G Chiba needle to desired calyx without needle holder guidance in all patients. Our approach according to probe was transverse. Results: Our patients comprised of 24 men and 35 women aged 24 to 66 years. Thirteen of them had no hydronephrosis and their stone sizes ranged from 21 mm to 65 mm. Patients in the ureteral stent group were more obese compared to the non-stent group (P=0.02) in addition to significantly more operation time (P=0.03). However hydronephrosis was not significantly different between groups (P=0.3). Postoperative residual stone rate, hospital stay days and complications (Fever, blood transfusion) were the same between both groups. Only urinary leak was more common in the non-stent group (P=0.04) Conclusion: Ultra-sonographic-PCNL without inserting ureteral catheter before surgery is conceivable especially in patients with lower body mass index (BMI). Advantages and complications are same in ureteral stent and non-stent patients except urinary leak that is more common in non-stent patients.

A systematic review and meta-analysis of effect of synthetic erythropoietin on hemoglobin in dialysis patients

Introduction: Anemia is a common complication of chronic kidney disease (CKD) due to the insufficient production of erythropoietin by the kidneys. The administration of erythropoietin is one of the most common methods for the treatment of patients with anemia. Objectives: This study aimed to investigate the effect of the administration of synthetic erythropoietin on hemoglobin levels in dialysis patients using a systematic review and meta-analysis. Methods: In order to identify the related studies, the international databases of Web of Science, PubMed, Scopus, and Embase were searched from 2015 to 2020 using standard and valid keywords. The data were analyzed using STATA software (version 14), and a p-value of less than 0.05 was considered statistically significant. Results: In 12 reviewed articles with a sample size of 4,060 individuals, the standard effect size of the effect of synthetic erythropoietin on Hb in dialysis patients was reported as 2.08 (95% CI: 1.53-2.63), which was statistically significant; however, erythropoietin biosimilars did not show similar results. Conclusion: The administration of erythropoietin to hemodialysis patients increases Hb levels by more than 2 units.

Serum fetuin-A levels and its relationship with biochemical parameters in hemodialysis patients

Introduction: Cardiovascular events are the most important complications of end-stage renal disease (ESRD). The role of fetuin-A and vascular calcification inhibitors in cardiovascular complications, dysregulated biochemical markers, and mortality is uncertain in patients under hemodialysis. Objectives: The aim of this study was to investigate the relationship of fetuin-A with cardiovascular complications and biochemical markers in hemodialysis patients. Patients and Methods: In this cross-sectional study, 65 patients undergoing hemodialysis were enrolled. Blood samples were taken at pre-dialysis to determine serum fetuin-A, calcium, phosphorus, intact parathyroid hormone (iPTH), C-reactive protein (CRP), albumin, triglyceride, total cholesterol, as well as blood hemoglobin, and hematocrit. The data was analyzed considering the statistical significance level of 0.05. Results: Out of 65 patients, seven patients died during the study, and 58 patients were finally evaluated. Mean (±SD) serum fetuin-A level was 1268.71 ± 1229.4 μg/mL. There was no significant difference in the mean fetuin-A level between genders (P=0.904). There were no significant correlations between the serum level of fetuin-A and age, duration of dialysis, heart diseases, serum levels of calcium, phosphorus, PTH, albumin, CRP, cholesterol and finally blood hemoglobin. However, significant relationships were found between fetuin-A level and serum triglyceride (TG) level (P=0.019) and body mass index (BMI) (P=0.024). Conclusion: Fetuin-A level was significantly associated with serum TG level and BMI. Regarding the links of obesity and hypertriglyceridemia with cardiovascular diseases (CVDs), controlling serum TG level and body weight can reduce the risk of vascular atherosclerosis in patients undergoing dialysis.