Chronic inflammation and progression of chronic kidney disease in patients with type 2 diabetes

Chronic inflammation, atherosclerosis, tubulointerstitial fibrosis, and vascular damage play a crucial role in the progression of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (DM). However, specific biomarkers that can determine the progression of diabetic kidney disease, including patients with minimal albuminuria, remain undefined. The present study aimed to determine markers of chronic inflammation as indicators of CKD progression in patients with type 2 DM. Methods. 45 patients with type 2 DM and stage 1-3 CKD were involved in this cross-sectional observational study. Analysis of cellular mechanisms of CKD progression was performed on the concentrations of endothelin-1 (ET-1), fibronectin (FN), tumor necrosis factor-alpha (TNF-α), transforming growth factor beta-1 (TGF-β1), and monocyte chemoattractant protein (MCP) -1) in the serum. Results. In patients with type 2 DM, an increasing trend in the majority of endothelial and proinflammatory mediators was found according to the CKD stages despite normal albuminuria. Conclusions. Concentrations of TNF-α, ET, TGF-β1 and MCP-1 can be used to assess the progression of CKD in patients with type 2 DM with normal albuminuria. Further researches are needed to determine early indicators of diabetic kidney disease progression.

Neonatal Bartter syndrome: A case report from Northern India

Bartter Syndrome is a rare genetic disorder affecting the renal tubular system causing a decreased absorption of sodium and chloride in the thick ascending limb of the Henle loop. Most children present in infancy with complaints of polyuria, polydipsia, vomiting, constipation and failure to thrive while older children present with recurrent episodes of dehydration, muscle weakness and cramps. The present study aimed to demonstrate a case of Bartter syndrome presenting as acute gastroenteritis.

Can body shape index indicate obesity-associated inflammation and cardiovascular diseases in stage 3-4 chronic kidney disease patients?

The incidence and prevalence of obesity are increasing rapidly throughout the world. Various methods have been developed to evaluate obesity. A body shape index (aBSI) is based on waist circumference adjusted for height and weight. High BSI values have been found to be associated with early mortality. It is known that obesity is associated with inflammation and cardiovascular diseases. In this study, we examined the relationship between aBSI, inflammatory markers such as C-reactive protein and interleukin-6 and cardiovascular disease in patients with stage 3-4 chronic kidney disease. Methods. One hundred twenty patients were enrolled in this cross-sectional observational study. The mean aBSI value was 0.0870. Patients were divided into 2 groups according to the mean value of aBSI as there is no currently defined cut-off value for BSI. Those with aBSI ≤ 0.087 were allocated to group I, and those with aBSI> 0.0870 to group II. Results. Patients in group II had more cardiovascular disease than in group I. In partial Spearman correlation analysis, the presence of cardiovascular disease was correlated with aBSI (r = 0.36, p = 0.0001). aBSI higher than 0.0986 predicted cardiovascular disease in our cohort: the area under the curve (CI 95%) for aBSI was 0.715 (0.602-0.829). Conclusions. The relationship between aBSI and inflammation could not be shown. But we found that high aBSI is associated with increased cardiovascular disease. Further studies are needed to recommend the routine clinical use of aBSI as a cardiovascular disease marker.

Prediction of unfavorable outcome in ischemic stroke patients with chronic kidney disease

Patients with chronic kidney disease (CKD) have significantly poorer functional outcomes and greater mortality after suffering a stroke. The present study aimed to identify the prognostic factors of an unfavorable outcome of the ischemic stroke in patients with CKD. Methods and subjects. The current study was designed retrospectively and performed with data of patients who were hospitalized due to ischemic stroke to the neurological department. A complex clinical and neuroimaging investigation was carried out in 65 patients (30 men and 35 women) aged 53 to 81 years (mean age – (67.7 ± 5.9) years) with acute stroke and CKD. Patients underwent all the necessary ancillary investigations according to guidelines. According to the clinical outcome on the 21-st day by the modified Rankin scale (mRS) all patients were divided into two groups: 1-st –favorable stroke outcome (mRS=0-3) – 34 (52.3%), 2-nd – unfavorable stroke outcome – (mRS=4-6) – 31 (47.7%). Results. During comparing the basic characteristics of both groups, it was revealed that patients with unfavorable functional outcomes were almost twice as likely to have diabetes mellitus (51.6% vs. 26.5%, p<0.037) and atrial fibrillation (41.9% vs. 17.6%, p<0.032). In age-and sex-adjusted multifactor logistic regression it was found that ischemic stroke unfavorable outcome is associated with diabetes mellitus (OR – 2.5, CI: 1.6-8.3; p=0.014), atrial fibrillation – 2.7, CI: 0.7-9.6; p=0.043), dialysis therapy (OR – 3.4, CI: 2.3-8.1; p=0.007), GFR <42 ml/min/1.73 m2 (OR – 2.7, CI: 2.1-7.8; p=0.003). Conclusions. Determining prognostic factors of unfavorable course of the ischemic stroke in patients with CKD allows to optimize the management of such patients in the acute period of ischemic stroke and improve the prognosis.

Pregnancy and delivery in women treated with renal replacement therapy: A literature review

The problem of pregnancy and delivery in women with end-stage kidney disease is becoming increasingly important, and the number of such women who are pregnant, receiving kidney replacement therapy, is growing every year. Improvements in dialysis therapy have led to improved obstetric and perinatal outcomes, but the risk of various obstetric and perinatal complications remains extremely high. In this review, we analyzed recently published data on management and outcomes of pregnancy in women with end-stage kidney disease receiving dialysis.

Clinical profile, management and outcomes of class IV emphysematous pyelonephritis in a tertiary care center: A retrospective descriptive study

Class IV Emphysematous pyelonephritis (EPN) is a life-threatening infection of the kidney, and there is sparse data on immediate and long-term outcomes of medical management. The study aimed to review the clinical presentation, diagnosis, immediate and long-term outcomes of medical management, and outcome of patients presenting with class IV EPN Methods. This retrospective study was conducted in a tertiary care center in Dharwad, India. The study included class IV EPN patients admitted to the hospital between Jan 2012 to Dec 2019. The factors studied were demographics, comorbidities, radiological investigations, clinical presentation, urine, blood and pus culture, and sensitivity and treatment history. Immediate and long-term outcomes of medical management were determined. Descriptive analysis of the data was conducted. Continuous variables were presented as mean ± standard deviation and discrete variables in terms of number (%). Results. Twenty-one patients with class IV EPN, with a mean age of 55.7 ±13.5 years, were analyzed. The majority were males (M: F 15:6). The patients were followed up for 32.70±21.12 months. Fever, flank or abdominal pain, and acute kidney injury were observed in all 21 patients, while nausea and/or vomiting and dysuria were seen in 16 (76.2%) patients. E. Coli was the most common pathogen found. Double J stenting was done in 20 (95.2%) patients; Ultrasonography guided aspiration 8(38.1%) and percutaneous drainage in 5 (23.8%) patients. One (4.8%) patient died during the first episode and 3(19%) others due to recurrent infection and end-stage renal disease. Conclusions. Class IV Emphysematous pyelonephritis can be managed successfully by minimally invasive modalities. However, long-term morbidity and mortality risks are still negative.

Activation of oxidative stress, comorbidity and survival of end-stage renal disease patients treated with hemodialysis

The aim of the study was to analyze the characteristics of serum concentrations of oxidative stress (OS) markers depending on the quantitative assessment of comorbidity and taking into account the most informative indicators of OS, to prospectively assess changes in comorbid status, death rates and individual comorbid conditions in patients with end-stage renal disease (ESRD) treated with hemodialysis (HD). Methods. The cohort prospective open-label study included 156 patients with ESRD, treated with HD. The study was conducted in two stages. In the first – the structure and quantitative assessment of comorbid diseases, determination of serum concentrations of oxidative stress (OS) markers and their analysis depending on the comorbid status were studied. On the second – taking into account the defined threshold values (Cut-off) of the most informative markers of the OS, an assessment of changes in comorbid status, frequency of comorbid conditions and fatal events done. A modified polymorbidity index (MPI) was calculated to assess comorbid status. The concentration of OS serum markers was determined by spectrophotometric method. Statistical analysis was performed by using "MedCalc", version 19.3 (Ostend, Belgium). Results. Serum concentrations of all prooxidant markers were significantly higher and antioxidant markers were significantly lower in the HD patients with high comorbid status compared to those of patients with low comorbidity (p<0.0001). Correlation analysis between MIP and the studied OS markers showed that the largest correlation (rho=0.874) was established with the serum concentration of malondialdehyde (MDAs). During the observation period in the group of patients with a concentration of MDAs > 668.72 μmol/ml found a significant, compared with the group with a biomarker content ≤ 668.72 μmol/ml, an increase in the proportion of patients with chronic obstructive pulmonary disease (COPD) (by 81.84 % vs 28.48 %; p<0.0001), cardiovascular diseases (CVD) (by 56.0 % vs 36.4 %; p=0.019) and cerebrovascular (CEVD) diseases (by 73.33 % vs 30.42 %; p<0.0001). The proportion of patients with fractures in the group of patients with MDAs > 668.72 μmol/l increased fourfold (p=0.0140). The increase in MIP is 34.11 % vs 17.1 % (p<0.0001), five-year cumulative survival – 45.3 % vs 63.3 % (p=0.0312; HR – 2,1527, 95% CI: 1,2458 –3,7199), five-year CV survival – 61,6 % vs 80.8 % (p=0.0094; HR – 2.7955, 95% CI: 1.3664 – 5.7191) in groups with MDAs > 668.72 and ≤ 668.72 μmol/ml, respectively. Conclusions. In patients with ESRD, treated with HD, serum concentrations of MDAs > 668.72 μmol/l is a biochemical determinant of a significant increase, in the medium term, the number of comorbid conditions, deaths, fatal CV and CEVD events, the proportion of patients with COPD, fractures, CVD and CEVD, reduction of cumulative and CV survival.

The beneficial effect of a phytonutrient-rich product against cadmium chloride-induced hepatorenal toxicity

This study was designed to investigate the hepatorenal protective effects of trévo, on cadmium-induced renal and hepatic injury in male Wistar rats. Methods. Fifteen healthy male Wistar rats were divided into three groups of five rats per group. Group I (control); group II (35mg/kg cadmium chloride (CdCl2); Group III (2 ml/kg trévo+ CdCl2. The rats were treated with trévo (2ml/kg orally) and administered CdCl2 3 hrs later. Twenty-four hours after the last administration rats were sacrificed and blood was collected via cardiac puncture and processed for hematological parameters and assessment of urea, creatinine (CREA), and uric acid (UA), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and albumin (ALB). The liver and kidney were excised and processed for markers of oxidative stress. Results intraperitoneal administration of 35 mg/kg of CdCl2 caused a significant increase in serum concentration of urea, CREA, UA, AST, ALT, while the concentration of ALB was significantly lower (P<0.0001). CdCl2 caused a significant reduction in packed cell volume, hemoglobin while the total white blood cell count, neutrophils, lymphocytes, monocytes, eosinophils, and basophils were increased. Oxidative stress was significantly pronounced in the liver and kidney of rats exposed to CdCl2 as observed in the high concentration of malondialdehyde, decreased concentration of glutathione, the activity of catalase, superoxide dismutase, and glutathione-S-transferase. Pretreatment with trévo was able to significantly prevent the anemic, oxidative damage, renal and hepatic injury initiated by CdCl2. Conclusions. The study reveals that trévo is effective in attenuating cadmium-induced hepatorenal toxicity in male Wistar rats.

Malignancies in renal transplant recipients: A retrospective single-center descriptive study

The risk of malignancy development in kidney transplant recipients (KTRs) is 2-3 times higher than in the general population. This picture, which emerged with chronic immunosuppressive use, has become more prominent in recent years as the ongoing cause of death in this population. This study aims to determine the common features of KTRs with malignancy in follow-up under a single-center experience. Thus, it is to save time by correctly determining our focus points in patient follow-up. Methods. The files of 403 patients who underwent kidney transplantation between 2005 and 2020 in our hospital were reviewed retrospectively. The clinical findings at admission were age, gender, primary disease, use of cyclophosphamide before transplant, duration of dialysis, number of human leukocyte antigen mismatch, transplantation time, previous rejection, the existence of associated viral infections, comorbid diseases, used induction therapy, maintenance immunosuppressive therapy, allograft survival, recipient survival, malignancy development time after transplantation, serum creatinine, glomerular filtration rate (GFR) and presence of proteinuria and hematuria. Using these data, we retrospectively analyzed the incidence and types of malignancies in KTRs. Results. During the follow-up period, 22cancer cases have been developed. The median age of the patient was 60 years (IQR 45-64.3) and patients were mostly male (77.3%) The median follow-up period was 111.5 months (IQR76.3–128.3). The median duration of dialysis was 54 months (IQR 11.5-78). The etiology of primary kidney disease in most KTRs recipients was unknown. The percentage of patients with mismatch 3 and above 3 was 86.3%. While the majority of patients received anti-thymocyte globulin (86.4 %) as induction therapy, maintenance therapy was mostly tacrolimus + mycophenolate mofetil + prednisolone (86.4 %). The median time from transplantation to the initial malignancy was 17.5 months (IQR 5-61.3). The most common initial malignancy was skin cancer (22.7%), followed by renal cell carcinoma originating from the native kidney (18.2%). Conclusion. Renal transplantation is the most favorable renal replacement therapy. Malignancies are now among the important causes of death in KTRs and these patients have a higher risk of developing cancer than the general population. Therefore, screening for cancer at certain intervals, especially in long-term and elderly recipients after transplantation, will positively affect the survival of the patient and functional renal graft.

Effect of omega-3 fatty acid on contrast-induced nephropathy

Renal failure that develops acutely after the use of iodinated contrast material is called "contrast-induced nephropathy". It is a complication with high morbidity and mortality risk. Current treatments are aimed at protecting kidney functions, new treatment methods are being researched. This study aims to demonstrate the therapeutic effects of omega-3 fatty acids on CIN, taking into account the possible clinical usage of iodinated contrast media and the benefits of omega-3 fatty acids. Methods. A total of 30 rats were studied, divided into four groups. Only saline was administered by gavage to group 1, only IV urography to group 2, only 400 mg omega-3 to group 3, and urography and 400 mg omega-3 to group 4. At the end of the study, kidney tissue and serum oxidative and antioxidant markers, and creatinine levels were analyzed. Result. While the degrees of glutathione peroxidase, catalase and total antioxidant capacity in kidney tissue and serum tests of rats treated with omega-3 fatty acid increased statistically; total oxidant capacity and malondialdehyde levels were found to be significantly lower. Furthermore, blood urea nitrogen and creatinine levels were found to be significantly lower in the omega-3 treated group. Conclusion. Omega-3 fatty acids had therapeutic effects in the experimental CIN model. As a result, we believe omega-3 fatty acids can be used as an alternative to existing supportive medicines in this common disease with few therapy options.