ISRN Nephrology The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Urinary Biomarkers of Acute Kidney Injury in Patients with Liver Cirrhosis Sun, 06 Apr 2014 06:49:24 +0000 Acute kidney injury (AKI) is a common complication in cirrhotic patients. Serum creatinine is a poor biomarker for detection of renal impairment in cirrhotic patients. This study aimed to evaluate urinary neutrophil gelatinase-associated lipocalin (NGAL) and urinary interleukin-18 (IL-18) as early biomarkers of acute kidney injury in cirrhotic patients. 160 patients with cirrhosis admitted to the Liver Units at Zagazig University Hospitals were classified into three groups: (I) nonascitic patients, (II) ascitic patients without renal impairment, and (III) ascitic patients with renal impairment. Patients with renal impairment were further divided into four subgroups: [A] prerenal azotemia, [B] chronic kidney disease (CKD), [C] hepatorenal syndrome (HRS), and [D] acute tubular necrosis (ATN). Significant elevation of both urinary NGAL and urinary IL-18 in cirrhotic patients with renal impairment especially in patients with ATN was observed. Urinary NGAL and urinary IL-18 have the ability to differentiate between AKI types in patients with cirrhosis. This could improve risk stratification for patients admitted to the hospital with cirrhosis, perhaps leading to early ICU admission, transplant evaluation, and prompt initiation of HRS therapy and early management of AKI. Anass Ahmed Qasem, Salama Elsayed Farag, Emad Hamed, Mohamed Emara, Ahmed Bihery, and Heba Pasha Copyright © 2014 Anass Ahmed Qasem et al. All rights reserved. Angiotensin Type-1 Receptor Blockade May Not Protect Kidney against Cisplatin-Induced Nephrotoxicity in Rats Sun, 16 Mar 2014 10:43:21 +0000 Background. Cisplatin (CDDP) is an anticancer drug, which is accompanied with major side effects including nephrotoxicity. We tested two doses of losartan (10 and 20 mg/kg/day) against nephrotoxicity in a rat model treated with daily administration of CDDP (2.5 mg/kg/day). Methods. Five groups of rats were examined. Groups 1 and 2 received losartan 10 and 20 mg/kg/day, i.p, for a period of 10 days. Group 3 received saline for 10 days, but from day 3 the animals received CDDP (2.5 mg/kg/day, i.p) for the next seven days. Groups 4 and 5 received treatment regimen the same as groups 1 and 2, but from day 3 they also received CDDP for the next seven days. At the end of the experiment, blood samples were obtained and the kidneys were removed to undergo pathological investigation and to obtain supernatant from homogenized tissue. Results. CDDP induced nephrotoxicity, but the serum levels of creatinine and blood urea nitrogen were not attenuated by losartan. The pathological findings confirmed that losartan did not have nephroprotective effect in this experimental model. Conclusion. According to the findings, losartan could not improve renal function impaired by toxicity induced by continuous doses of CDDP, and also it worsened the renal failure. Roya Rastghalam, Mehdi Nematbakhsh, Mehrnoosh Bahadorani, Fatemeh Eshraghi-Jazi, Ardeshir Talebi, Maryam Moeini, Farzaneh Ashrafi, and Soheila Shirdavani Copyright © 2014 Roya Rastghalam et al. All rights reserved. Effect of α-Lipoic Acid on Oxidative Stress in End-Stage Renal Disease Patients Receiving Intravenous Iron Wed, 05 Mar 2014 13:39:36 +0000 Oxidative stress is associated with increased risk of cardiovascular disease in end-stage renal disease (ESRD) patients. Intravenous (IV) iron has been shown to increase oxidative stress. The aim of the study was to evaluate changes in oxidative stress markers following administration of IV sodium ferric gluconate (SFG) to ESRD patients with and without administration of the antioxidant, α-lipoic acid. This is an open-label, crossover study. 125 mg of IV SFG was administered during control (C) and intervention (I) visits. During the I visit, 600 mg of α-lipoic acid was given orally prior to IV SFG. Blood samples were collected at defined time periods for F2-isoprostane (FIP), lipid hydroperoxide (LHP), malondialdehyde (MDA), and iron indices. We recruited ten African-American ESRD subjects: 50% male; mean age years; mean hemoglobin  g/dL; ferritin  ng/mL; transferrin saturation %. There were no significant differences in iron indices between the two visits after IV SFG. MDA, FIP, and LHP increased significantly for both C and I visits with a greater increase in the I group. Administration of IV SFG results in an acute rise in oxidative stress in ESRD patients. In contrast to previous studies, administration of α-lipoic acid was associated with a greater increase in oxidative stress. Arif Showkat, William R. Bastnagel, and Joanna Q. Hudson Copyright © 2014 Arif Showkat et al. All rights reserved. The Utility of Serial Allograft Biopsies during Delayed Graft Function in Renal Transplantation under Current Immunosuppressive Regimens Wed, 05 Mar 2014 08:05:19 +0000 Delayed graft function (DGF) of kidney transplants increases risk of rejection. We aimed to assess the utility of weekly biopsies during DGF in the setting of currently used immunosuppression and identify variables associated with rejection during DGF. We reviewed all kidney transplants at our institution between January 2008 and December 2011. All patients received rabbit antithymocyte globulin/Thymoglobulin (ATG) or Basiliximab/Simulect induction with maintenance tacrolimus + mycophenolate + corticosteroid therapy. Patients undergoing at least one weekly biopsy during DGF comprised the study group. Eighty-three/420 (19.8%) recipients during this period experienced DGF lasting ≥1 week and underwent weekly biopsies until DGF resolved. Biopsy revealed significant rejection only in 4/83 patients (4.8%) (one Banff 1-A and two Banff 2-A cellular rejections, and one acute humoral rejection). Six other/83 patients (7.2%) had Banff-borderline rejection of uncertain clinical significance. Four variables (ATG versus Basiliximab induction, patient age, panel reactive anti-HLA antibody level at transplantation, and living versus deceased donor transplants) were statistically significantly different between patients with and without rejection, though the clinical significance of these differences is questionable given the low incidence of rejection. Conclusions. Under current immunosuppression regimens, rejection during DGF is uncommon and the utility of serial biopsies during DGF is limited. Hilana H. Hatoum, Anita Patel, and K. K. Venkat Copyright © 2014 Hilana H. Hatoum et al. All rights reserved. Proteinuria, 99mTc-DTPA Scintigraphy, Creatinine-, Cystatin- and Combined-Based Equations in the Assessment of Chronic Kidney Disease Tue, 11 Feb 2014 11:35:28 +0000 Background. Precise estimation of the glomerular filtration rate (GFR) and the identification of markers of progression are important. We compared creatinine, cystatin, and combined CKD-EPI equations with scintigraphy to measure GFR and proteinuria as markers of progression. Methods. Cross-sectional, observational study including 300 subjects. CKD was classified by scintigraphy. Determinations. Creatinine, 24-hour creatinine clearance, cystatin, Hoek formula, and creatinine, cystatin, and combined CKD-EPI equations. Results. In the global assessment, creatinine CKD-EPI and combined CKD-EPI equations yielded the highest correlations with : ρ = 0.839, and ρ = 0.831, . Intergroup analysis versus : control G, creatinine clearance ρ = 0.414, P = 0.013; G3, combined CKD-EPI ρ = 0.5317, ; G4, Hoek ρ = 0.618, , combined CKD-EPI ρ = 0.4638, ; and G5, creatinine clearance ρ = 0.5414, , combined CKD-EPI ρ = 0.5288, . In the global assessment, proteinuria displayed the highest significant correlations with cystatin (ρ = 0.5433, ) and cystatin-based equations (Hoek: , ). When GFR < 60 mL/min: in stage 3, proteinuria-cystatin (ρ = 0.4341, ); proteinuria-Hoek (ρ = −0.4105, ); in stage 4, proteinuria-cystatin (ρ = 0.4877, ); proteinuria-Hoek (ρ = −0.4877, P = 0.0026). Conclusions. At every stage of GFR < 60 mL/min, cystatin-based equations displayed better correlations with . Proteinuria and cystatin-based equations showed strong associations and high degrees of correlation. Hernán Trimarchi, Alexis Muryan, Agostina Toscano, Diana Martino, Mariano Forrester, Vanesa Pomeranz, Fernando Lombi, Pablo Young, María Soledad Raña, Alejandra Karl, M. Alonso, Mariana Dicugno, and Clara Fitzsimons Copyright © 2014 Hernán Trimarchi et al. All rights reserved. Long Term Prospective Assessment of Living Kidney Donors: Single Center Experience Thu, 23 Jan 2014 00:00:00 +0000 Virtually, all studies reporting the outcomes of living kidney donation beyond the first year from donation were retrospective. In this prospective study, the outcome of 81 consecutive living kidney donors was thoroughly evaluated. Clinical, laboratory, and radiological assessments were carried out at predonation (basal), 3, 6, 12, and 24 months after donation. The mean age at time of donation was 37.8 ± 9.8 years and the majority was females (75.3%). The mean BMI increased significantly after donation (). The mean serum creatinine levels (mg/dl) were 0.75 ± 0.14, 1.01 ± 0.22, 0.99 ± 0.21, 0.98 ± 0.20, and 0.94 ± 0.20 (). Likewise, the mean levels of measured creatinine clearance (mL/min) were 148.8 ± 35.7, 94.7 ± 26.6, 95.5 ± 24.6, 96.7 ± 20.2, and 101.6 ± 26.2 (). The mean 24 hours urinary protein excretion (gm/dL) were 0.09 ± 0.03, 0.19 ± 0.18, 0.16 ± 0.09, 0.18 ± 0.25, and 0.17 ± 0.12 (). There were significant increases in the means of the longitudinal and transverse diameters of the remaining kidney over time (). Out of 42 female donors, eleven female donors have got successful postdonation pregnancies. There were no reported surgical complications, either intra- or postoperative. Long-term follow-up is necessary for all living kidney donors through local institutional and world registries. This trial is registered with NCT00813579. Ayman Maher Nagib, Ayman Fathi Refaie, Yasser Abdelmoniem Hendy, Magdy Abass Mohmed Elfawal, Ahmed Abdelrahman Shokeir, Mohamed Adel Bakr, Ahmed Hassan Neamattala, Ahmed Farouk Hamdy, Khaled Mohamed Mahmoud, Amani Mostafa Ismail, and Mohamed Ahmed Ghoneim Copyright © 2014 Ayman Maher Nagib et al. All rights reserved. Hyaluronan Is Not a Ligand but a Regulator of Toll-Like Receptor Signaling in Mesangial Cells: Role of Extracellular Matrix in Innate Immunity Tue, 21 Jan 2014 14:14:02 +0000 Glomerular mesangial cells (MC), like most cell types secrete hyaluronan (HA), which attached to the cell surface via CD44, is the backbone of a hydrophilic gel matrix around these cells. Reduced extracellular matrix thickness and viscosity result from HA cleavage during inflammation. HA fragments were reported to trigger innate immunity via Toll-like receptor-(TLR-) 2 and/or TLR4 in immune cells. We questioned whether HA fragments also regulate the immunostimulatory capacity of smooth muscle cell-like MC. LPS (TLR4-ligand) and PAM3CysSK4 (TLR2-ligand) induced IL-6 secretion in MC; highly purified endotoxin-free HA 3000 Da up to 50 μg/mL did not. Bovine-testis-hyaluronidase from was used to digest MC-HA into HA fragments of different size directly in the cell culture. Resultant HA fragments did not activate TLR4-deficient MC, while TLR2-deficient MC responded to LPS-contamination of hyaluronidase, not to produced HA fragments. Hyaluronidase increased the stimulatory effect of TLR2-/-3/-5 ligands on their TLR-receptors in TLR4-deficient MC, excluding any effect by LPS-contamination. Supplemented heparin suppressed every stimulatory effect in a dose-dependent manner. We conclude that the glycosaminoglycan HA creates a pericellular jelly barrier, which covers surface receptors like the TLRs. Barrier-thickness and viscosity balanced by HA-synthesis and degradation and the amount of HA-receptors on the cell surface regulate innate immunity via the accessibility of the receptors. Rainer Ebid, Julia Lichtnekert, and Hans-Joachim Anders Copyright © 2014 Rainer Ebid et al. All rights reserved. Cystatin C at Admission in the Intensive Care Unit Predicts Mortality among Elderly Patients Thu, 24 Oct 2013 15:43:02 +0000 Introduction. Cystatin C has been used in the critical care setting to evaluate renal function. Nevertheless, it has also been found to correlate with mortality, but it is not clear whether this association is due to acute kidney injury (AKI) or to other mechanism. Objective. To evaluate whether serum cystatin C at intensive care unit (ICU) entry predicts AKI and mortality in elderly patients. Materials and Methods. It was a prospective study of ICU elderly patients without AKI at admission. We evaluated 400 patients based on normality for serum cystatin C at ICU entry, of whom 234 (58%) were selected and 45 (19%) developed AKI. Results. We observed that higher serum levels of cystatin C did not predict AKI ( versus  mg/L; ). However, it was an independent predictor of mortality, H.R. = 6.16 (95% CI 1.46–26.00; ), in contrast with AKI, which was not associated with death. In the ROC curves, cystatin C also provided a moderate and significant area (0.67; ) compared to AKI (0.47; ) to detect death. Conclusion. We demonstrated that higher cystatin C levels are an independent predictor of mortality in ICU elderly patients and may be used as a marker of poor prognosis. Maria Aparecida Dalboni, Daniel de Oliveira Beraldo, Beata Marie Redublo Quinto, Rosângela Blaya, Roberto Narciso, Moacir Oliveira, Júlio César Martins Monte, Marcelino de Souza Durão, Miguel Cendoroglo, Oscar Fernando Pavão, and Marcelo Costa Batista Copyright © 2013 Maria Aparecida Dalboni et al. All rights reserved. Paracetamol Interference in Uric Acid Levels in Uremic Patients Revealed by Monitoring Spent Dialysate Thu, 03 Oct 2013 14:47:11 +0000 The aim of this study was to assess removal dynamics of paracetamol (PAR), as an extraordinary chromophore in spent dialysate, upon the optical monitoring of dialysis of end-stage renal disease patients with inflammation complications. Seven dialysis sessions of different patients were followed to whom PAR was used as a pain reliever or antipyretic. Spent dialysate was sampled hourly and analyzed using HPLC with MS/MS and UV detection. Quantitative calculations were made on the basis of the peak areas on the chromatograms at 280 nm for uric acid (UA) and 254 nm for PAR and its metabolites (PAR-M). Peaks of UA, PAR, PAR-glucuronide, and PAR-sulphate were identified on the basis of specific mass spectra. Removal of PAR was found to be proportional to that of uric acid if intake of the drug by patient occurred half a day before dialysis. But disturbances of the UV-absorbance curves at 280 nm were observed related to rise of UA concentration in spent dialysate when PAR was taken by patients in the course of dialysis. The mechanism of such relation remains unknown. It was concluded that possible benefits and risks of treatment of uremic patients with paracetamol-containing drugs may need to be reassessed. Risto Tanner, Jürgen Arund, Ivo Fridolin, and Merike Luman Copyright © 2013 Risto Tanner et al. All rights reserved. The Pleiotropic Effect of Vitamin D Wed, 04 Sep 2013 14:14:15 +0000 The novel roles of vitamin D were discovered and valued in this century. In addition to the maintenance of calcium and phosphorus balance, vitamin D regulates the function of the kidneys, heart, and immune system. Moreover, its anti-inflammatory, antiapoptotic, and antifibrotic roles have gained considerable attention. Vitamin D is also important for the maintenance of homeostasis by regulation of hormone secretion, cell proliferation, and differentiation. This paper will review these pleiotropic functions of vitamin D. Yu-Hsien Lai and Te-Chao Fang Copyright © 2013 Yu-Hsien Lai and Te-Chao Fang. All rights reserved. Prevalence of Chronic Kidney Disease and Its Related Risk Factors in Elderly of Southern Iran: A Population-Based Study Sun, 07 Jul 2013 13:13:34 +0000 Aim. The prevalence of chronic kidney disease (CKD) as a serious public health problem is growing in the elderly. This study aimed to assess CKD prevalence and its related risk factors in elderly population of Fars province. Methods. In this cross sectional study a total of 1190 elderly people are enrolled, and demographic and medical data were obtained. Data were analyzed by SPSS, and P of less than 0.05 was considered as statistically significant. Results. Prevalence of CKD stages III–V was 27.5% in the 60–69 years age group, 36.5% in the 70–79 years age group, and 40% in the ≥80 years age group. The prevalence of CKD increased with ageing in both men and women. Female gender was the strongest risk factor for CKD. Conclusions. Prevalence of CKD in elderly is high in Southern Iran, which has become an important health problem while it can be prevented or delayed in progression. Leila Malekmakan, Parviz Khajehdehi, Maryam Pakfetrat, Alireza Malekmakan, Hamideh Mahdaviazad, and Jamshid Roozbeh Copyright © 2013 Leila Malekmakan et al. All rights reserved. Vitamin E Is a Nephroprotectant Agent in Male but Not in Female in a Model of Cisplatin-Induced Nephrotoxicity Sun, 23 Jun 2013 13:48:41 +0000 Background. The role of gender for nephroprotectant agent such as vitamin E in cisplatin- (CP-) induced nephrotoxicity has not been documented yet. Methods. One group from each gender of Wistar rats received a single dose of CP (7 mg/kg; i.p) and was treated with vitamin E (1 g/kg/day) for 7 days, and they were compared with similar gender in the control group. Results. The serum levels of blood urea nitrogen (BUN) and creatinine (Cr) in male animals treated with CP was not different from the control group, but it was significantly different in the female rats (). The CP-induced damage intensity in male kidney tissue was not significantly different between the CP-treated and control groups, but this was not the case in female, indicating that the tissue damage in female is significantly different from the control group (). No significant difference in serum levels of magnesium (Mg), nitrite, malondialdehyde (MDA), and lactate dehydrogenase (LDH) was seen between the genders. Kidney weight and body weight changes were statistically significant in both genders (). Significant difference was observed in uterus weight between the two groups of female (). Conclusion. Vitamin E may prevent CP-induced nephrotoxicity in male, but possibly it has not such nephroprotectant effect in female. Sima Jilanchi, Mehdi Nematbakhsh, Mehrnoosh Bahadorani, Ardeshir Talebi, Fatemeh Eshraghi-Jazi, Azam Mansouri, and Farzaneh Ashrafi Copyright © 2013 Sima Jilanchi et al. All rights reserved. Lack of Influence of Serum Magnesium Levels on Overall Mortality and Cardiovascular Outcomes in Patients with Advanced Chronic Kidney Disease Wed, 19 Jun 2013 15:44:00 +0000 Background. Low serum magnesium has been associated with an increased cardiovascular risk in the general population and in dialysis patients. Our aim was to analyze the influence of serum magnesium on overall mortality and cardiovascular outcomes in patients with advanced CKD not yet on dialysis. Methods. Seventy patients with CKD stages 4 and 5 were included. After a single measurement of s-magnesium, patients were followed a mean of 11 months. Primary end-point was death of any cause, and secondary end-point was the occurrence of fatal or nonfatal CV events. Results. Basal s-magnesium was within normal range ( mg/dL), was lower in men and in diabetic patients , and was not different between patients with and without cardiopathy. Magnesium did not correlate with PTH, calcium, phosphate, albumin, inflammatory parameters (CRP), and cardiac (NT-proBNP) biomarkers but correlated inversely ; with the daily dose of loop diuretics. In univariate and multivariate Cox proportional hazard models, magnesium was not an independent predictor for overall mortality or CV events. Conclusions. Our results do not support that serum magnesium can be an independent predictor for overall mortality or future cardiovascular events among patients with advanced CKD not yet on dialysis. Olimpia Ortega, Isabel Rodriguez, Gabriela Cobo, Julie Hinostroza, Paloma Gallar, Carmen Mon, Milagros Ortiz, Juan Carlos Herrero, Cristina Di Gioia, Aniana Oliet, and Ana Vigil Copyright © 2013 Olimpia Ortega et al. All rights reserved. Urine Bag as a Modern Day Matula Thu, 23 May 2013 15:19:35 +0000 Since time immemorial uroscopic analysis has been a staple of diagnostic medicine. It received prominence during the middle ages with the introduction of the matula. Urinary discoloration is generally due to changes in urochrome concentration associated with the presence of other endogenous or exogenous pigments. Observation of urine colors has received less attention due to the advances made in urinalysis. A gamut of urine colors can be seen in urine bags of hospitalized patients that may give clue to presence of infections, medications, poisons, and hemolysis. Although worrisome to the patient, urine discoloration is mostly benign and resolves with removal of the offending agent. Twelve urine bags with discolored urine (and their predisposing causes) have been shown as examples. Urine colors (blue-green, yellow, orange, pink, red, brown, black, white, and purple) and their etiologies have been reviewed following a literature search in these databases: Pubmed, EBSCO, Science Direct, Proquest, Google Scholar, Springer, and Ovid. Stalin Viswanathan Copyright © 2013 Stalin Viswanathan. All rights reserved. Decrease Rate of the Renal Diameter in Chronic Hemodialysis Patients Wed, 22 May 2013 16:00:53 +0000 We here present the results of ultrasonographic (US) evaluations on the alteration of renal diameter of chronic HD patients. Of 109 outpatient HD patients who had neither severe acquired cystic disease of the kidney nor hereditary polycystic kidney disease, we performed US two or three times to measure their maximum renal diameter (mean of both kidneys), and the yearly alteration rate was calculated. The average interval of the two measurements was 35.9 months, and the average HD duration from the HD induction to the first measurement was 29.5 months. The average decrease rate of renal diameter was (SE) mm/year. No statistical difference was seen on the decrease rate in relation to gender, age and original disease (among three groups, glomerulonephritis and IgA nephropathy, diabetes, and others including hypertension). However, the decrease rate was large when the first measurement was close to the induction of hemodialysis, suggesting that the alteration rate reduced according to the hemodialysis vintage ( mm/year, first measurement not more than 10 months after induction of HD and  mm/year, first measurement more than 80 months after induction of HD). Renal diameter decreased approximately 4.3 mm each year, and the decrease rate slowed as the length of time on dialysis increased. Teiichiro Aoyagi, Masaaki Tachibana, and Shinji Naganuma Copyright © 2013 Teiichiro Aoyagi et al. All rights reserved. Current Understanding of Guanylin Peptides Actions Wed, 17 Apr 2013 12:33:49 +0000 Guanylin peptides (GPs) family includes guanylin (GN), uroguanylin (UGN), lymphoguanylin, and recently discovered renoguanylin. This growing family is proposed to be intestinal natriuretic peptides. After ingestion of a salty meal, GN and UGN are secreted into the intestinal lumen, where they inhibit sodium absorption and induce anion and water secretion. At the same conditions, those hormones stimulate renal electrolyte excretion by inducing natriuresis, kaliuresis, and diuresis and therefore prevent hypernatremia and hypervolemia after salty meals. In the intestine, a well-known receptor for GPs is guanylate cyclase C (GC-C) whose activation increases intracellular concentration of cGMP. However, in the kidney of GC-C-deficient mice, effects of GPs are unaltered, which could be by new cGMP-independent signaling pathway (G-protein-coupled receptor). This is not unusual as atrial natriuretic peptide also activates two different types of receptors: guanylate cylcase A and clearance receptor which is also G-protein coupled receptor. Physiological role of GPs in other organs (liver, pancreas, lung, sweat glands, and male reproductive system) needs to be discovered. However, it is known that they are involved in pathological conditions like cystic fibrosis, asthma, intestinal tumors, kidney and heart failure, obesity, and metabolic syndrome. Aleksandra Sindic Copyright © 2013 Aleksandra Sindic. All rights reserved. Diabetes Insipidus: A Challenging Diagnosis with New Drug Therapies Sun, 24 Mar 2013 08:41:42 +0000 Diabetes Insipidus (DI) is either due to deficient secretion of arginine vasopressin (central) or to tubular unresponsiveness (nephrogenic). Drug induced DI is a well-known entity with an extensive list of medications. Polyuria is generally defined as urine output exceeding 3 liters per day in adults. It is crucial to identify the cause of diabetes insipidus and to implement therapy as early as possible to prevent the electrolyte disturbances and the associated mortality and morbidity. It is very rare to have an idiosyncratic effect after a short use of a medication, and physicians should be aware of such a complication to avoid volume depletion. The diagnosis of diabetes insipidus is very challenging because it relies on laboratory values, urine output, and the physical examination of the patient. A high clinical suspicion of diabetes insipidus should be enough to initiate treatment. The complications related to DI are mostly related to the electrolyte imbalance that can affect the normal physiology of different organ systems. Chadi Saifan, Rabih Nasr, Suchita Mehta, Pranab Sharma Acharya, Isera Perrera, Giovanni Faddoul, Nikhil Nalluri, Mayurakhan Kesavan, Yorg Azzi, and Suzanne El-Sayegh Copyright © 2013 Chadi Saifan et al. All rights reserved. Sex-Related Difference in Nitric Oxide Metabolites Levels after Nephroprotectant Supplementation Administration against Cisplatin-Induced Nephrotoxicity in Wistar Rat Model: The Role of Vitamin E, Erythropoietin, or N-Acetylcysteine Mon, 11 Mar 2013 17:57:48 +0000 Background. Nitric oxide (NO) concentration in serum is altered by cisplatin (CP), and NO influences CP-induced nephrotoxicity. The effect of nephroprotectant agent supplementation (vitamin E, human recombinant erythropoietin (EPO), or n-acetylcysteine (NAC)) on the NO metabolites levels after CP administration in the two genders was determined. Methods. Sixty-four adult Wistar rats were randomly divided into 10 groups. Male and female rats in different groups received vehicle (saline), CP (7 mg/kg) alone, CP plus EPO (100 IU/kg), CP plus vitamin E (250 mg/kg), and CP plus NAC (600 mg/kg). CP was administrated as a single dose, but the supplementations were given for a period of 7 days. Results. In male rats, the serum levels of total NO metabolites (NOx) and nitrite were increased significantly () by CP. However, vitamin E significantly reduced the serum levels of these metabolites, which was increased by administration of CP (), and such findings were not observed for female rats. The EPO or NAC did not influence NO metabolites neither in male rats nor in female rats. Conclusion. Although vitamin E, EPO, and NAC are reported to be nephroprotectant agents against CP-induced nephrotoxicity, only vitamin E could reduce the level of all NO metabolites only in male rats. Mehdi Nematbakhsh and Zahra Pezeshki Copyright © 2013 Mehdi Nematbakhsh and Zahra Pezeshki. All rights reserved. Glomerular Disease in Patients with Infectious Processes Developing Antineutrophil Cytoplasmic Antibodies Tue, 19 Feb 2013 09:07:36 +0000 To identify differences in treatment and outcome of various types of glomerulonephritis developing in the course of infections triggering antineutrophil cytoplasmic antibody (ANCA) formation, we analyzed published reports of 50 patients. Immunosuppressives were added to antibiotics in 22 of 23 patients with pauci-immune glomerulonephritis. Improvement was noted in 85% of 20 patients with information on outcomes. Death rate was 13%. Corticosteroids were added to antibiotics in about 50% of 19 patients with postinfectious glomerulonephritis. Improvement rate was 74%, and death rate was 26%. Two patients with mixed histological features were analyzed under both pauci-immune and post-infectious glomerulonephritis categories. In 9 patients with other renal histology, treatment consisted of antibiotics alone (7 patients), antibiotics plus immunosuppressives (1 patient), or immunosuppressives alone (1 patient). Improvement rate was 67%, permanent renal failure rate was 22%, and death rate was 11%. One patient with antiglomerular basement disease glomerulonephritis required maintenance hemodialysis. Glomerulonephritis developing in patients who became ANCA-positive during the course of an infection is associated with significant mortality. The histological type of the glomerulonephritis guides the choice of treatment. Pauci-immune glomerulonephritis is usually treated with addition of immunosuppressives to antibiotics. Konstantin N. Konstantinov, Suzanne N. Emil, Marc Barry, Susan Kellie, and Antonios H. Tzamaloukas Copyright © 2013 Konstantin N. Konstantinov et al. All rights reserved. Serum NGAL in Critically Ill Children in ICU from a Single Center in Egypt Sun, 03 Feb 2013 08:35:26 +0000 Introduction. The mortality and morbidity associated with acute kidney injury (AKI), unfortunately, remain unacceptably high. We aimed to detect the extent of serum neutrophil gelatinase-associated lipocalin (NGAL) to early detect AKI in critically ill children. Subjects and Methods. This is a case control study. It included 75 subjects that include 15 as controls and 60 critically ill children. Patients were further subdivided according to RIFLE criteria into two other categories: patients who developed AKI and patients who did not develop AKI. Serum NGAL assayed on admission and after 3 days. Results. There was significant increase in the level of NGAL among patients group when compared with control group. Also, 21.7% of children admitted to PICU developed AKI from which 8.3% needed dialysis. The receiver operating characteristic curve of NGAL at day 0 revealed AUC of 0.63 with 95% CI of 0.50–0.77. At a cutoff value of 89.5 ng/mL, the sensitivity of NGAL was 84.6%, while specifcity was 59.6%, positive predictive value was 36.7%, negative predictive value was 68.4%, and accuracy was 93.3% in diagnosis of AKI. Conclusion. We found that NGAL acts as a sensitive marker rather than a specific one for AKI. At the same time, it presents as a negative predictive value more valuable than being a positive predictive value in detecting AKI. Doaa Mohammed Youssef, Asmaa Mohammed Esh, Ebthag Helmy Hassan, and Tahia Mohammed Ahmed Copyright © 2013 Doaa Mohammed Youssef et al. All rights reserved. Residual Renal Function in Hemodialysis Patients: The Role of Angiotensin-Converting Enzyme Inhibitor in Its Preservation Mon, 24 Dec 2012 13:33:36 +0000 Residual Renal function (RRF) has an important role in the overall morbidity and mortality in hemodialysis patients. The role of angiotensin-converting enzyme inhibitor (ACEi) in preserving renal function in chronic proteinuric nephropathies is well documented. We test the hypothesis that enalapril (an ACEi) slows the rate of decline of RRF in patients starting hemodialysis. A prospective, randomized open-label study was carried out. 42 patients were randomized in two groups either in treatment with enalapril or no treatment at all. Our study has proven that enalapril has a significant effect on preserving residual renal function in patients starting dialysis at least during the first 12 months from the initiation of the hemodialysis. Further studies are necessary in order to investigate the potential long-term effect of ACEi on residual renal function and on morbidity and mortality in patients starting hemodialysis. Dimitris Xydakis, Apostolos Papadogiannakis, Maria Sfakianaki, Konstantinos Kostakis, Konstantinos Stylianou, Ioannis Petrakis, Antonaki Ergini, Konstantinos Voskarides, and Eugeneios Dafnis Copyright © 2013 Dimitris Xydakis et al. All rights reserved. Comprehensive and Personalized Care of the Hemodialysis Patient in Tassin, France: A Model for the Patient-Centered Medical Home for Subspecialty Patients Sat, 22 Dec 2012 10:35:07 +0000 The Centre de Rein Artificiel in Tassin, France, provides comprehensive care to patients with chronic renal disease similar to the model proposed for Patient Center Medical Homes; patients with end-stage renal disease in the Tassin Hemodialysis Center appear to have better outcomes than patients in the United States. These differences likely reflect this center’s approach to patient-centered care, the use of longer dialysis times, and focused vascular access care. Longer dialysis times provide better clearance of small and middle toxic molecules, salt, and water; 85% of patients at the Tassin center have a normal blood pressure without the use of antihypertensive medications. The observed mortality rate in patients at the Tassin Center is approximately 50% of that predicted based on the United States Renal Data system standard mortality tables. Patient outcomes at the Tassin center suggest that longer dialysis times and the use of multidiscipline teams led by nephrologists directing all health care needs probably explain the outcomes in these patients. These approaches can be imported into the U.S healthcare system and form the framework for patient-centered medical practice for ESRD patients. Eva Anvari, Hoda Mojazi Amiri, Patricia Aristimuno, Charles Chazot, and Kenneth Nugent Copyright © 2013 Eva Anvari et al. All rights reserved. Pregnancy-Related Acute Kidney Injury: Experience of the Nephrology Unit at the University Hospital of Fez, Morocco Thu, 20 Dec 2012 10:29:20 +0000 Introduction. Acute kidney injury (PRAKI) continues to be common in developing countries. The aim of this paper is to study AKI characteristics in pregnancy and identify the factors related to the unfavorable evolution. Methods. This prospective study was conducted in the University Hospital Hassan II of Fez, Morocco, from February 01, 2011 to January 31, 2012. All patients presenting PRAKI were included. Results. 37 cases of PRAKI were listed. Their ages varied from 20 to 41 years old, with an average of 29.03 ± 6.3 years and an average parity of 1.83. High blood pressure was the most common symptom (55.6%). Thirty-nine percent were oliguric. PRAKI occurred during the 3rd trimester in 66.6% of the cases and 25% of the cases in the postpartum. Hemodialysis was necessary in 16.2% of cases. The main causes were preeclampsia, hemorrhagic shocks, and functional, respectively, in 66.6%, 25%, and 8.3% of the cases. The outcome was favorable, with a complete renal function recovery for 28 patients. Poor prognosis was related to two factors: age over 38 years and advanced stage of AKI according to RIFLE classification. Conclusion. Prevention of PRAKI requires an improvement of the sanitary infrastructures with the implementation of an obligatory prenatal consultation. Mohamed Arrayhani, Randa El Youbi, and Tarik Sqalli Copyright © 2013 Mohamed Arrayhani et al. All rights reserved. Dialysis Efficiency of AN69, a Semisynthetic Membrane Not Well Suited for Diffusion Thu, 20 Dec 2012 08:16:57 +0000 AN69 membrane is not suited for diffusion, with an suggested limit at 25 mL/min dialysate flow rate. When prescribing continuous hemodialysis this threshold must be surpassed to achieve. We designed a study aimed to check if a higher dose of dialysis could be delivered efficiently with this membrane. Ten ICU patients under continuous hemodiafiltration with 1.4 m2 AN69 membrane were included and once a day we set the monitor to exclusively 50 mL/min dialysate flow rate and 250 mL/min blood flow rate and after 15 minutes measured dialysate saturation for urea, creatinine, and -microglobulin. We detected that urea saturation of dialysate was nearly complete () for at least 40 hours, while creatinine saturation showed a large dispersion () and did not detect any relation for these variables with time, blood flow, or anticoagulation regime. Saturation of -microglobulin was low () and decreased discretely with time (, ) and significantly with TMP increases (, ). In our experience AN69 membrane shows a better diffusive capability than previously acknowledged, covering efficiently the range of standard dosage for continuous therapies. Creatinine is not a good marker of the membrane diffusive capability. M. E. Herrera-Gutiérrez, G. Seller-Pérez, D. Arias Verdu, C. Jironda-Gallegos, M. Martín-Velázquez, and G. Quesada-García Copyright © 2013 M. E. Herrera-Gutiérrez et al. All rights reserved. Impact of Improving Quality of Dialysis Fluid on Oxidative Stress and Lipid Profile in Hemodialysis Patients Wed, 19 Dec 2012 13:20:45 +0000 The aim of this study was to evaluate the levels of malondialdehyde as an oxidative stress marker in the same hemodialysis patients after changing the quality of dialysate with ultrapure dialysis fluid. Methods. This prospective study concerns hemodialysis patients; all patients were in the first step treated with conventional dialysate, and in the second step (three months later) the same patients were treated with online produced ultrapure dialysis fluid. The malondialdehyde, C-reactive protein, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, fibrinogen, and albumin were quantified before the two steps. Results. Thirty-seven patients completed the study. Ultrapure dialysis fluid reduced but not significantly the malondialdehyde concentrations. Both dialysis fluids were associated with improvement in the malondialdehyde level before and after the hemodialysis session. In lipid parameters, there was a significant decrease with conventional dialysis fluid versus ultrapure dialysis fluid of triglycerides, total cholesterol, and high-density lipoprotein in patients’ blood. Instead, the level of low-density lipoprotein, fibrinogen, albumin, and C-reactive protein does not change significantly. Conclusion. The lipid parameters were improved for triglycerides and total cholesterol. Malondialdehyde increases following the hemodialysis session, and the conventional dialysate increased malondialdehyde levels more than the ultrapure dialysis but the differences were not statistically significant. Driss Elkabbaj, Abdelali Bahadi, Yahia Cherrah, Mourad Errasfa, and Rachid Eljaoudi Copyright © 2013 Driss Elkabbaj et al. All rights reserved. Membrane Bioincompatibility and Ultrafiltration Effects on Pulse Wave Analysis during Haemodialysis Mon, 17 Dec 2012 15:08:00 +0000 Membrane bioincompatibility was demonstrated by successive white blood cell counts and C3a generation. Pulse wave analysis was obtained by applanation tonometry (SphygmoCor) in a sequential way: basal, after 30 minutes with nul ultrafiltration, and after a complete dialysis with ultrafiltration. At 15 minutes of haemodialysis, significant decrease in leukocyte count occurred: versus (), while C3a levels sharply increased from to  ng/mL (). No changes were observed in augmentation index without ultrafiltration: versus . Only aortic systolic blood pressure was lower at 15 minutes: versus  mmHg (), in agreement with a reduction in brachial systolic blood pressure: versus  mmHg (), without changes in aortic or brachial diastolic blood pressure. Important changes in pulse wave analysis were observed after a complete haemodialysis session: augmentation index versus , aortic systolic blood pressure versus mmHg (), without changes in aortic diastolic blood pressure. In summary, haemodialysis with cellulose diacetate acutely induced a transient state of immunoactivation due to bioincompatibility, this phenomenon was nondetectable by pulse wave analysis. Complete haemodialysis session led to important changes in pulse wave analysis. Maria-Pau Valenzuela, Jaume Almirall, and María-José Amengual Copyright © 2013 Maria-Pau Valenzuela et al. All rights reserved. Hepatitis C Virus Infection and Dialysis: 2012 Update Mon, 17 Dec 2012 15:04:06 +0000 Hepatitis C virus infection is still common among dialysis patients, but the natural history of HCV in this group is not completely understood. Recent evidence has been accumulated showing that anti-HCV positive serologic status is significantly associated with lower survival in dialysis population; an increased risk of liver and cardiovascular disease-related mortality compared with anti-HCV negative subjects has been found. According to a novel meta-analysis (fourteen studies including 145,608 unique patients), the adjusted RR for liver disease-related death and cardiovascular mortality was 3.82 (95% CI, 1.92; 7.61) and 1.26 (95% CI, 1.10; 1.45), respectively. It has been suggested that the decision to treat HCV in patients with chronic kidney disease be based on the potential benefits and risks of therapy, including life expectancy, candidacy for kidney transplant, and co-morbidities. According to recent guidelines, the antiviral treatment of choice in HCV-infected patients on dialysis is mono-therapy but fresh data suggest the use of modern antiviral approaches (i.e., pegylated interferon plus ribavirin). The summary estimate for sustained viral response and drop-out rate was 56% (95% CI, 28–84) and 25% (95% CI, 10–40) in a pooled analysis including 151 dialysis patients on combination antiviral therapy (conventional or pegylated interferon plus ribavirin). Fabrizio Fabrizi Copyright © 2013 Fabrizio Fabrizi. All rights reserved. NGAL Usefulness in the Intensive Care Unit Three Hours after Cardiac Surgery Tue, 27 Nov 2012 13:42:12 +0000 Objective. Neutrophil gelatinase-associated lipocalin (NGAL) measured by a research ELISA is described as an early marker of acute kidney injury (AKI). The aim of this study is to define the usefulness of plasma NGAL (pNGAL) and urine NGAL (uNGAL) measured with platform analysers to detect AKI 3 hours after cardiac surgery in fifty adult patients. Methods and Main Results. pNGAL and uNGAL were measured before and 3 hours after cardiac surgery. AKI, defined following the acute kidney injury network definition, was observed in 17 patients. pNGAL was >149 ng/mL in 8 patients with AKI, two of them died in the follow-up. We also observed elevated pNGAL in 8 patients without AKI. Only one uNGAL was >132 ng/mL among the 15 AKI patients. Sensitivity of pNGAL for prediction of AKI is 47% and specificity is 75.7%. The positive likelihood ratio (LR+) is 1.9 and negative likelihood ratio (LR−) is 0.7. uNGAL performance is slightly improved when reported to urinary creatinine. Following this study, a ratio >62 ng/mg assure a sensitivity of 66.6% and a specificity of 78.5%. LR+ is 3 and a LR− is, 0.42. Conclusions. Three hours after cardiac surgery, pNGAL predicts AKI with a low sensitivity and specificity. Geoffray Delcroix, Nicole Gillain, Martial Moonen, Luc Radermacher, François Damas, Jean-Marc Minon, and Vincent Fraipont Copyright © 2013 Geoffray Delcroix et al. All rights reserved. Effect of N-Acetylcysteine on Residual Renal Function in Chronic Haemodialysis Patients Treated with High-Flux Synthetic Dialysis Membranes: A Pilot Study Mon, 26 Nov 2012 13:57:18 +0000 Background. Preservation of residual renal function in chronic dialysis patients has proven to be a major predictor of survival. The aim of the present study was to investigate an ability of the combined use of N-acetylcysteine and high-flux biocompatible haemodialysis membranes to improve residual renal function in haemodialysis patients. Patients and Methods. Chronic haemodialysis patients with a residual urine output of at least 100 mL/24 h were administered oral an N-acetylcysteine 1200 mg twice daily for 2 weeks. Treatment group included patients treated with dialysers using high-flux synthetic biocompatible membranes. Control group included patients treated with dialysers using low-flux semisyntetic triacetate haemodialysis membranes. Results. Eighteen patients participated in the study. The residual glomerular filtration rate showed a nonsignificant trend for increase in both groups. The magnitude of GFR improvement after N-acetylcysteine administration was less pronounced in the group treated with high-flux biocompatible membranes: +0.17 ± 0.56 mL/min/1.73 m2 in treatment group and +0.65 ± 0.53 mL/min/1.73 m2 in control group (). Conclusion. In this study of favorable effect of N-acetylcysteine on residual renal function in chronic haemodialysis patients may be less pronounced when using high-flux biocompatible, rather than low-flux semisyntetic, HD membranes. Leonid Feldman, Ramzia Abu Hamad, Shai Efrati, Ali Ashker, Ilia Beberashvili, and Michal Shani Copyright © 2013 Leonid Feldman et al. All rights reserved. Usefulness of Change in Estimated Glomerular Filtration Rate as a Predicting Factor of Progression of Chronic Kidney Disease Mon, 26 Nov 2012 13:37:28 +0000 Purpose. To explore factors contributing to chronic kidney disease (CKD) progression and change in estimated glomerular filtration rate over time (ΔeGFR) as a risk factor in predialysis patients under multidisciplinary managements. Methods. Among 113 CKD patients, eGFR, serum creatinine, total protein, albumin, urea nitrogen, uric acid, calcium, inorganic phosphate, total cholesterol, urinary creatinine, urinary protein (UP), hemoglobin A1c, hemoglobin, and hematocrit were analyzed. Results. ΔeGFR analysis in the first six months presented a positive slope (remission group) in 43 patients (38%) and a negative slope (no-remission group) in 70 patients (62%). Three-year dialysis-free rate was 89.4% in the remission group and 39.3% in the no-remission group, with a significant difference (). To explore factors contributing to dialysis initiation by stepwise Cox regression, baseline eGFR (HR 0.706, ) and ΔeGFR in the first six months of treatment (HR 0.075, ) were identified. To investigate factors affecting remission and no remission by stepwise logistic regression, age (odds ratio 1.06, ) and UP excretion (odds ratio 1.223, ) were identified. Conclusion. Monitoring of ΔeGFR and UP is not only useful in suppressing CKD 3 progression, but also in deciding strategies to achieve remission in individual patients. Kunimi Maeda, Chieko Hamada, Satoshi Horikoshi, and Yasuhiko Tomino Copyright © 2013 Kunimi Maeda et al. All rights reserved.