Research Article
3/10/2017
Mohammad Soleimani, Navid Masoumi
Background:
Assisted reproductive technique is the last treatment resort for idiopathic male infertility (IMI). In recent years, antioxidants have received vast attention to treat IMI by decreasing seminal oxidative stress.
Methods:
In this cross-sectional before-after study, we evaluated the effects of grape seed extract (GSE) as an antioxidant on seminal chemistry. 29 patients with IMI were treated with GSE 600 mg per day for 3 months. Seminal catalase, superoxide dismutase and malondialdehyde, and serum FSH, LH, and testosterone levels were evaluated both at the beginning and at the end of the study.
Results:
Mean age of the patients was 32.5 ± 4.9 years. GSE consumption resulted in increased semen catalase (44.67 ± 17.11 vs. 53.05 ± 18.6, P = 0.016), decreased semen malondialdehyde (1.77 ± 0.48 vs. 1.55 ± 0.43, P = 0.024), and increased serum FSH (3.53 ± 1.51 vs. 4.3 ± 2.00, P = 0.026).
Conclusions:
Our study revealed GSE effectiveness in decreasing seminal oxidative stress in patients suffering from IMI.
Research Article
7/10/2017
Seyed Mohammadreza Rabani, Ali Mousavizadeh
Background:
Ureterovesical junction obstruction (UVJO) is the result of an anatomic or a functional abnormality in the distal segment of the ureter. There are many types of UVJO, different in their cause, presentation, imaging characters, and prognosis.
Objectives:
The aim of this study was to discuss the postoperative natural course and prognosis of patients undergoing standard approaches on the management of primary UVJO by one surgeon in a 10-year period starting from 2004.
Methods:
From January 2004 to October 2013, 64 patients who underwent ureteral tapering and stenting ureteroneocystostomy for complicated primary UVJO participated in the study.
Results:
The mean age of patients was 26 years (range: 11 months to 73 years). The mean hospital stay was 5 days (range: 4 to 7 days). The post-operative time was between 1 and 2 hours. Double J stent was left in place for 4 weeks. Post-operative follow-up was at least one year. No major complication was encountered, instead, a decrease in symptoms in all patients and an increase in renal function in 40 out of 64 (62.5%) patients were observed in the one-year follow-up of the diethylenetriaminepentaacetic acid (DTPA) renal scanning. Only 3 patients had fever as a postoperative minor complication.
Conclusions:
Decision making in the treatment of UVJO is somewhat a dilemma. This condition is occasionally asymptomatic and uneventful, and may be detected accidentally during an unrelated work-up; nonetheless, it may also cause serious life threatening complications. Surgical management in complicated cases may be a safe and viable treatment option both in children and in adults.
Research Article
3/10/2017
Keiji Hirai, Shigeki Imamura, Susumu Ookawara, Aizan Hirai, Yoshiyuki Morishita
Objectives:
Dulaglutide and liraglutide are glucagon-like peptide-1 receptor agonists. We investigated the effects of once-weekly dulaglutide on glycemic control and renal function compared to once-daily liraglutide in patients with advanced-stage diabetic nephropathy.
Methods:
Changes over a 12-month period in levels of glycated hemoglobin, urine protein/creatinine ratio, and annual change in estimated glomerular filtration rate were retrospectively analyzed in 10 patients with advanced-stage diabetic nephropathy after changing from once-daily liraglutide (0.9 mg/day) to once-weekly dulaglutide (0.75 mg/week) (dulaglutide group). The control group comprised 10 patients with advanced-stage diabetic nephropathy who had continued once-daily liraglutide (0.9 mg/day) (liraglutide group).
Results:
The glycated hemoglobin level significantly decreased in the dulaglutide group after switching from liraglutide to dulaglutide (-0.81 ± 1.03% at 12 months from baseline, P < 0.05), but no change occurred in the liraglutide group. The urine protein/creatinine ratio and annual change in estimated glomerular filtration rate did not change in either groups.
Conclusions:
Once-weekly dulaglutide may be more advantageous for glycemic control compared to once-daily liraglutide in patients with advanced-stage diabetic nephropathy.
Review Article
3/10/2017
Alireza Akhavan Rezayat, Mohammad Aslezare, Hassan Ahmadnia, Salman Soltani, Amirabbas Asadpour
Recent prophylactic treatment options and diagnostic tools show a suboptimal improvement in patients with renal angiomyolipoma (AML). This study was an attempt to review management strategies applied before invasive options. An extensive research on medical databases such as PubMed and Scopus was performed from 1999 to 2016 using the following keywords: ‘kidney’, ‘renal’, and ‘angiomyolipoma’. All related studies on patients treating with conservative or minimally-invasive procedures were included. However, reports on surgical treatments were excluded. Treatment strategies have been selected based on outcomes resulting from computed tomography (CT) and magnetic resonance (MR) imaging. Fat content and tumor size are the most common used indications for AMLs. Unenhanced CT and chemical shift imaging provide good evidence in case of fat-poor AMLs. Chemical analysis and percutaneous biopsy are recommended in case of a diagnostic challenge. A tumor size of 6 cm or larger in diameter might necessitate invasive treatment, while AMLs patients with tumors around 4 cm may require prophylactic treatment. Of all treatment options, embolization indicated a high risk of reintervention. Moreover, everolimus and sirolimus as 2 inhibitors of mammalian target of rapamycin (mTOR) have been evaluated in clinical trials and demonstrated promising outcomes. In conclusion, advances in imaging techniques along with mTOR inhibitors and embolic materials potentiate functional outcomes in AMLs.
Case Report
3/10/2017
Leonardo Spatola, Claudio Angelini, Carlo Selmi, Silvia Santostasi, Francesco Reggiani, Raimondo Boeri, Domenico Mavilio, Salvatore Badalamenti
Introduction:
In this report, we present a rare case of HCV-negative cryoglobulinemic glomerulonephritis and recurrent prostate cancer in a 79-year-old Caucasian man. In the literature, only a few cases of solid cancer-associated cryoglobulinemia have been reported, but none have shown both renal involvement and prostate cancer.
Case Presentation:
A 79-year-old Caucasian man with limb and abdominal purpura, peripheral edema, nausea, and oligoanuric renal failure was admitted to our renal unit in July 2016. In 2007, the patient was successfully treated with radiotherapy for localized prostate cancer and underwent regular follow-up until July 2016 when he developed a recurrence of prostate cancer and was treated with radiotherapy. He was obese and affected by hypertension and stable mild chronic kidney disease (last serum creatinine level, 1.4 mg/dL in July 2016). Serum creatinine level was 5.9 mg/dL upon admission, and blood urea nitrogen was 250 mg/dL with a urinary output of almost 400 ml/day. He tested negative for HCV infection, but positive for type II cryoglobulinemia. Considering the severity of the clinical course of renal biopsy, renal histology was performed, demonstrating cryoglobulinemic membranoproliferative glomerulonephritis. Given the concomitant recurrence of prostate adenocarcinoma, pulse steroid therapy was initiated, followed by prednisone (1 mg/kg/day), without using others immunotherapy agents, such as cyclophosphamide and/or rituximab. Limb and abdominal purpura improved after steroid therapy, whereas renal function failed to recover and hemodialysis treatment was initiated after positioning a central venous catheter. Hemodialysis treatment ameliorated the clinical status of our patient, who is still under chronic treatment.
Conclusions:
Type II mixed cryoglobulinemia (MC) is a vasculitis of unknown etiology. HCV infection is the major cause of nearly 90% of MC cases. However, contribution of genetic and/or environmental factors remains controversial, as approximately 10% of MC cases present no evidence of HCV infection. These cases are defined as essential MC and are generally associated with a severe course of and suboptimal responses to conventional therapies. This documented report provides the basis for a comprehensive literature review of the rare occurrence of HCV-negative paraneoplastic cryoglobulinemia.
Research Article
3/10/2017
Seyed Mohammadreza Amouzegar, Marzieh Lak
Background:
Short-term pulsatile perfusion during cardio pulmonary bypass has shown higher protection for renal physiology, following standard preservation of glomerular filtration and reduction of renal tissue damage.
Methods:
In this randomized clinical trial study, 70 patients, who had undergone CABG surgery were divided to 2 groups; pulsatile and non-pulsatile groups. The researchers transferred continuous blood flow to pulsatile blood flow during proximal graft using cardiac contraction. Patients’ laboratory tests, such as blood urea nitrogen (BUN) and creatinine were checked preoperatively, at the arrival of the open heart intensive care unit (ICU-OH), and 24 and 48 hours after admission.
Results:
Both case and control groups had significantly increased BUN and creatinine. Increased creatinine on the first and second postoperative day was significantly higher in the control group. Furthermore, BUN increased on the second day in the control group and was significantly higher than the case group
Conclusions:
Despite the rise in BUN and creatinine in the 2 groups, there were no cases of renal failure in the patients. However, the results of this study regarding creatinine and BUN criteria were supported by the pulsatile perfusion method during the proximal graft by using a cardiac contraction in CABG surgery.
Research Article
3/10/2017
Kobra Shiasi, Farbod Talebian, Seyyed Peyman Khamechi, Hassan Nikoueinejad, Mojtaba Sehat, Zohreh Azarbad, Behzad Einollahi
Background:
The main indicator of long-term glycemic control in type 1 diabetes and its complications is glycosylated hemoglobin (HbA1c). Considering that there are little studies on the correlation of YKL-40 with HbA1C in type 1 diabetes, we evaluated such correlation to suggest YKL-40 as both diagnostic and prognostic marker of type 1 diabetes poor control and nephropathy.
Methods:
49 patients of type 1 diabetes not suffering from any diabetic complications during recent 5 years and 43 sex- and age-matched healthy controls participated in the study. Taking fasting blood and urine samples, we measured CBC, serum levels of YKL-40, HbA1c, creatinine, lipids, and urinary concentration of albumin and creatinine using standard laboratory methods.
Results:
Serum level of YKL-40 was significantly higher in type 1 diabetes compared to controls (P < 0.001). There was no significant correlation between such levels and HbA1c (P = 0.99) in type 1 diabetic patients. There was a strong positive correlation between YKL-40 and duration of the disease (P < 0.001). We found no significant correlation between serum level of YKL-40 and other factors including urine/albumin creatinine ratio (UACR), blood pressure, lipid profile, and serum and urine creatinine.
Conclusions:
Although there was a significant increase in serum level of YKL-40 in type 1 diabetic patients, it did not show any correlation with both metabolic and nephropathic states of diabetes.
Research Article
16/10/2017
Parsa Yousefichaijan, Masoud Rezagholizamenjany, Fatemeh Dorreh, Hassan Taherahmadi, Mohamad Rafiei, Sahar Aslani, Ali Arjmand
Introduction:
Nocturnal enuresis is a symptom with probably multiple etiologic factors and a high prevalence. Conventional therapies is expensive and complicated, since the effect of calcium on voiding dysfunction was approved. Therefore, to the current study aimed at evaluating the therapeutic effect of hydrochlorothiazide on primary monosymptomatic nocturnal enuresis (PMNE).
Methods:
The current study was conducted based on the interviews with patients. Morning urine test was evaluated in children with PMNE detection and specific gravity < 1010 enrolled to the study (110 children comprised 57 cases and 53 controls). Children were divided into 2 groups; in the case group, hydrochlorothiazide tablet 1 mg/kg (maximum 50 mg) was administered in the morning and the control group was only given necessary training about enuresis. For 3 times and with 1 month interval (based on a predetermined questionnaire) the frequency of nocturnal enuresis was checked. Data were transferred into SPSS and the therapeutic effect of hydrochlorothiazide on PMNE was investigated.
Findings:
There was a statistically significant difference regarding the frequency of nocturnal enuresis between the 2 groups (P = 0.0001). Also, both groups were matched by age (P = 899) and gender (P = 607).
Conclusions:
Hydrochlorothiazide can be used as an effective and safe therapeutic option to treat PMNE.
Review Article
20/6/2017
Farid Azizi Jalilian, Mohammad Soleimani, Mohsen Alemi, Arefeh Bashiri, Ghazaleh Haghighat
PSA is the most routine marker to detect prostate cancer, but due to its low specificity that can lead to a number of unnecessary biopsies, there is great need for an alternate method. Can PCA3 be one of these methods? PCA3 is overexpressed in prostate cancer, not in benign conditions such as prostatitis (unlike PSA). Because of its efficacy (being more sensitive and specific in comparison with PSA), this biomarker could be a very useful and promising method for the early detection of prostate cancer, especially in combination with other tests such as TMPRSS2-ERG gene fusion.
Research Article
20/6/2017
Mohamad Hosein Nourbala, Alireza Ghadian, Zohreh Rostami, Shahin Abbaszadeh, Mahdi Azarabadi, Mahmod Salesi
Introduction:
Patients who undergo radical nephrectomy are considered as single kidney. In addition, most patients will develop CKD due to reduced kidney function. In this study, we monitored and compared kidney function results in patients with kidney tumors who had radical or partial nephrectomy.
Methods:
This cross sectional study was conducted on 129 patients who were admitted to … hospital from 2007 to 2012. There were 122 cases that had a radical nephrectomy and 7 patients who underwent a partial nephrectomy. The CKD was defined as eGFR < 60 mL/min/1.73m2 and the readings at the 1st, 3rd, and 5th year after the surgery were followed up.
Results:
In the first year of the follow up, there were 0% and 19.2% (P = 0.3) of patients with eGFR < 60 ml/min/1.73m2 in the partial and radical nephrectomy groups, respectively, which was not statically significant. However, it was increased to 63% (P = 0.05) at the 3rd year of follow up in the radical nephrectomy group and there was no new CKD reported in the partial nephrectomy patients. At the end of the follow up, 14.3% and 71.3% of patients developed CKD (P = 0.003).
Conclusions:
Radical nephrectomy is a risk factor for developing CKD. Therefore, radical nephrectomy should only be considered if the size and location of the tumor are not suitable for a partial nephrectomy.
Brief Report
4/7/2017
Giovanni Cavaliere, Elisa Zavattaro, Federica Veronese, Paolo Fava, Paola Savoia
Despite the well-known increased risk to develop non-melanoma skin cancer (NMSC) due to the long-term immunosuppression, data about melanoma incidence and prognosis in solid organ transplanted patients are still debated. Literature studies report a relative risk for melanoma varying from 1.2 and 5.8 in different solid organ recipients, probably as a consequence of the difference in immunosuppressive treatments and endogenous and exogenous risk factors. Here we report data about melanoma incidence, prognosis and clinicopathological characteristics in a series of 686 kidney transplant recipients. In this series, melanoma incidence was 3.5%; most cases were represented by in situ or thin melanomas mainly related to sun exposure, and the prognosis of our patients was good except for only one case with a progressive disease. Our experience confirms the importance of a regular dermatological follow-up and of education to correct sun exposure even in transplanted patients.
Research Article
22/8/2017
Yadollah Ahmadi Asr Badr, Ehsan Sepehran, Abbas Del Azar, Homayoun Sadeghi, Mohammad Nouri
Background:
Infertility affects 15% of couples and varicocele is the most common cause of male infertility. Oxidative stress is recommended as a possible mechanism of infertility. Crocus sativus (saffron) has been recognized as having antioxidative properties and is presumed to improve sperm parameters.
Objectives:
The present study aims to evaluate the effect of saffron on semen analysis of infertile men with clinical varicocele after varicocelectomy.
Methods:
In this randomized clinical trial, 48 infertile men candidates for varicocelectomy were randomly assigned to receive 60 mg edible saffron capsules once every other day (n = 27) or a similar regimen of placebo (n = 21) for 6 months. The two groups were compared for changes in semen parameters.
Results:
There was no significant difference between groups in semen parameters before treatment as well as in semen volume, morphology, and sperm count post-treatment, but motility was significantly higher in the saffron group (30.00 ± 14.46 vs. 21.71 ± 11.45; P = 0.03). There was one (3.7%) complication in the saffron group.
Conclusions:
Our results showed that except improving sperm motility, saffron has no effect on other semen parameters in infertile men with clinical varicocele after varicocelectomy.
Letter
14/7/2017
Hamidreza Karimi-Sari, Seyed Moayed Alavian
Research Article
19/9/2017
Alireza Kasra Dehkordi, Ali Tayebi, Abbas Ebadi, Hedayat Sahraei, Behzad Einollahi
Background:
Depression, anxiety, and stress are very common among hemodialysis patients. The aim of this study was to investigate effects of aromatherapy using the damask rose oil on depression, anxiety, and stress in these patients.
Methods:
In a clinical trial that was performed in 2015, 60 patients under hemodialysis treatment were randomly allocated to two groups of control and intervention each consisting of 30 subjects. The DASS21 scale was used to measure the rates of depression, anxiety, and stress before and four weeks after intervention. In the intervention group, the patients were asked to inhale the damask rose oil with a constant density of 2% from a piece of cloth smeared with three drops for an hour. In the control group, only the usual, standard care was applied.
Results:
The comparison of the mean scores before and after the intervention in the two groups showed that after intervention, the depression, anxiety, and stress scores significantly decreased in the damask rose group (P ≤ 0.05).
Conclusions:
Inhalation aromatherapy using the damask rose oil can decrease depression, anxiety, and stress in hemodialysis patients.
Research Article
21/8/2017
Maria Faye, Ahmed Tall Lemrabott, Khodia Fall, Mohamed Moustapha Cherif Dial, Mouhamadou Moustapha Cisse, Nisrine El Boumaoui, Moustapha Faye, Alex Rich Ismael Keita, Mansour Mbengue, Kane Yaya, Abdou Niang, Boucar Diouf, El Hadji Fary Ka
Introduction:
Crescentic extra-capillary glomerulonephritis (ECGN) is a diagnostic and therapeutic emergency. In black Africans, little data are available on this lesion. This study aimed at determining the clinical/biological and evolutionary patterns of ECGN and identifying factors of poor prognosis.
Methods:
This was a retrospective study conducted over a period of 5 years. All patients with extra-capillary proliferation of ≥ 50% in Bowman’s space upon kidney biopsy were involved. The researchers compared 2 groups of patients: group A (patients, who fully recovered from renal function after 3 months of treatment) and group B (patients developing signs of chronic renal insufficiency) in order to identify factors responsible for a poor renal prognosis.
Results:
Forty cases of crescentic glomerulonephritis were found in 750 kidney biopsies, i.e. a prevalence of 5.33%. The mean age of the patients was 33.9 ± 16.65 years, with a gender ratio of 0.53. Upon admission, 85% of cases had renal insufficiency, with oligoanuria present in 62.5%. By employing light microscopy, the crescents were found to be cellular in 60%, fibro-cellular in 32.5%, and fibrous in 7.5%. The etiologies were mainly lupus in 32.5% of cases, followed by ANCA-related vasculitis in 27.5% of cases, and infectious causes in 17.5% of cases. Outside of the infectious context, basic treatment relied on immune suppression combining corticosteroids and cytotoxic drugs. The evolution was marked by transition to a chronic state in 72.7% of cases; 18.2% of patients recovered normal renal function. The factors responsible for a poor renal prognosis were oligoanuria (P = 0.0008), high creatinine level upon admission (P = 0.0001), use of hemodialysis (P = 0.0001), and evidence of fibro-cellular and fibrous crescents (P = 0.013).
Conclusions:
Crescentic glomerulonephritis was relatively common in the current patients. The etiology was dominated by lupus in the study’s context. This rapidly causes chronic renal failure, hence explaining the interest in early management.
Case Report
10/10/2017
Sara Alvarez Rodriguez, Vital Hevia Palacios, Victoria Gomez Dos Santos, Victor Diez Nicolas, Francisco De Asis Donis Canet, Cristina Gonzalez Gordaliza, Francisco Javier Burgos Revilla
Introduction:
Transplantation of kidneys with anatomical variations like horseshoe kidneys is underused. Shortage of organs should make surgeons explore alternatives to using this type of allografts. A review of current literature, focused on the evaluation of these organs and surgical technique was performed.
Case Presentation:
Our experience with two cases is presented. The management of local complications, both vascular and obstructive, is shown.
Conclusions:
Transplantation of horseshoe kidneys is technically feasible, with optimal results in long-term follow-ups.
Brief Report
7/10/2017
Alireza Mehrazmay, Mahmood Salesi, Alireza Karambakhsh
Background:
There are some legislated criteria for improving the quality of articles’ abstract presentation.
Objectives:
The aim of this study was to evaluate oral and poster abstracts submitted at the first International Congress of Nephrology and Urology, held in Tehran during June, 2015.
Methods:
One hundred and forty-eight abstracts were assessed by 2 reviewers. Using the 19-item Timer checklist, the researchers examined the study design, number of au-thors, field of study, and language and quality score for each abstract. The comparisons between groups were done using the Mann-Whitney and Kruskal-Wallis tests by SPSS software with P values of less than 0.05 considered as significant.
Results:
The quality score mean of all articles of congress was 0.65±0.14. Structured abstracts (P = 0.026), articles of student field (P value = 0.032), and of human observational design (P value = 0.007) had a significantly better quality score. The best average score of the Timer checklist was related to subjects' appropriateness for the study question (1.89 ± 0.35) and the worst was related to method and appropriateness of subjective selection (0.89 ± 0.84).
Discussion:
Developing a specific quality scale for basic studies, assessing articles stricter before acceptance and necessitating authors to write their abstracts in structured form are required.
Research Article
7/10/2017
Hossein Keyhan, Sepideh Sedighi, Behruz Mashayekhi, Mehrnoush Fathi, Majeed Mokhtari
Objectives:
This study aimed at estimating the prevalence of bacterial strains isolated from patients with community acquired urinary tract infections (UTIs) and comparing the antibiotic susceptibility patterns among different genders.
Methods:
This prospective study was conducted between June 2011 and August 2012 in Iran, Tehran, on patients referred with symptomatic UTI. Midstream samples were taken and sent to the laboratory. The bacterial resistance was determined in patients with proven UTI by the Kirby Bauer’s disc diffusion method. Data were stratified by age and gender.
Results:
A total of 762 individuals were included in this prospective study, from which 573 (75.1%) were female and 189 (24.9%) were male patients. The most prevalent pathogen in different age, gender, inpatient and outpatient groups was Escherichia coli . The E. coli isolates were significantly higher in females compared to males (P = 0.03). High prevalence of resistance was observed against nalidixic acid (77.9%) in male patients, while amoxicillin (74%) was the most resistant antibiotic in females. However, the highest sensitivity was observed against imipenem in both male and female groups (97.9% and 97.2%, respectively) with no significant difference among them (P > 0.05).
Conclusions:
To date, this is the first study to determine the distribution and antibiotic susceptibility patterns in patients with UTI in Iran. This study showed that E. coli was the leading bacterial pathogen of community acquired UTIs in Iran, Tehran. An increasing resistance to first line antibiotics for UTI pathogens was also indicated, which emphases the need to improve empiric treatment.
