Prevalence and risk factors of urinary tract infection in kidney recipients: a meta-analysis study

BACKGROUND

A kidney recipient's urinary tract infection (UTI) can result in infectious problems and be a risk factor for less successful transplant outcomes. UTI risk factors are still controversial. The present study aimed to investigate the prevalence of UTI and its association with risk factors in kidney recipients.

METHOD

Twenty-six papers published between 2005 and 2022 were retrieved using keywords and searching Medlib, ScienceDirect, PubMed, and other databases. If possible, the pooled prevalence of UTI in kidney recipients and odds ratio (OR) with a 95% confidence interval for each risk factor were calculated. The data were analyzed using the random effects model in R and Stata 14.

RESULTS

The total sample size was 72,600, with an average age of 48.7 years. The pooled prevalence of UTI was 35% (95% CI, 30-40%). The estimated risk factors for UTI were female (OR = 3.13; 95%CI: 2.35-4.17), older age (OR = 1.03; 95%CI: 1-1.05), history of UTI (OR = 1.31; 95%CI) CI: 1.05-1.63), receiving a kidney from a deceased donor (OR = 1.59; 95%CI: 1.23-2.35), long-term use of an indwelling catheter (OR = 3.03; 95%CI: 1.59-6.59), a ureteral stent (OR = 1.54; 95%CI: 1.16-2.06), diabetes (OR = 1.17; 95%CI: 0.97-1.41), hypertension (OR = 1.6; 95%CI: 1.26-2.28), acute rejection process (OR = 2.22; 95%CI: 1.45-3.4), and abnormal urinary tract anatomy (OR = 2.87; 95%CI 1.44-5.74).

CONCLUSION

This meta-analysis revealed that UTIs are a significant problem in kidney recipients. Factors such as female sex, old age, history of UTIs, deceased donor, long-term use of an indwelling catheter, diabetes, acute rejection process, use of ureteral stent, abnormal urinary tract anatomy, and hypertension were related to an increased risk of UTIs in kidney recipients.

On the occassion of world kidney day 2023; renal impacts of COVID-19

World kidney day is an international campaign focused on bringing awareness to kidney health throughout the world and reducing the incidence of renal disease and its related medical complications. This mini-review sought to take a short look on the renal impact of SARS-CoV-2, with a particular focus on post-COVID-19 nephropathy as a new dilemma in the era of nephrology, which can be a new concern for nephrologists that requires more attention and particular strategies.

Effect of allopurinol on the treatment of chronic kidney disease: a systematic review and meta-analysis

Introduction: Chronic kidney disease (CKD) is defined by glomerular filtration rates (GFR) of less than 60 mL/min per 1.73 m2 or albumin to creatinine ratios of greater than 30 mg/g in urine for at least three months. Patients with CKD are at risk of developing the condition, leading to end-stage renal disease (ESRD). On the other hand, hyperuricemia can result in renal failure, increased blood pressure, fibrosis, and the progression of failure. In this study, using the meta-analysis method, we are looking to investigate the effect of allopurinol on the treatment of chronic renal failure. Materials and Methods: In this meta-analysis, which was written based on PRISMA (the Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol, International databases including Cochrane, Web of Science, Scopus, PubMed, and Google Scholar search engine were searched. The data were analyzed using STATA (version 14) software, and the significance level of tests was considered P<0.05. Results: In 13 studies with a sample of 1172 people, allopurinol significantly reduced the serum level of uric acid (SMD: -1.28; 95% CI: -1.74, -0.82) more than the control group (SMD: -0.96; 95% CI: -2.09, 0.17). Additionally, allopurinol reduced the systolic blood pressure level by (SMD: -0.32; 95% CI: -0.54, -0.11) mm Hg and it was effective in reducing diastolic blood pressure level by (SMD: -0.39; 95% CI: -0.60, -0.17) mm Hg. However, the difference in scores GFR, proteinuria, cystatin C, before and after allopurinol were not statistically significant. In the control group, the difference in scores before and after the intervention was not significant in any of the above-mentioned cases. Conclusion: In CKD, allopurinol is effective in reducing blood pressure and uric acid levels. However, due to the limited number of studies and the different type of treatment in the control group of the studied studies, it is suggested to conduct more studies in this field. Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO website (ID=CRD42022371439, regional ethical code #IR.IAU. NAJAFABAD.REC.1399.140).

The positive association between various demographic characteristics and peak expiratory flow in employees of Zanjan university of medical sciences

Introduction: Peak expiratory flow (PEF) is a reliable criterion for assessing respiratory capacity, and has a wide range of clinical application as a marker of asthma control. However, its wide variability undermines its efficacy. Objectives: This study was designed to evaluate PEF changes in staff of Zanjan University of Medical Sciences. Patients and Methods: Four hundred employees of this university participated in this cross-sectional study. Their PEF values were measured using peak flow meter in the morning at 8 AM and in the afternoon at 2 PM by three times for each individual, and then the highest amount of PEF was recorded about for measurement. Results: Obviously, PEF values were higher in the afternoon (43865 L/min) in comparison to the morning measurements (404.60 L/min) by paired t test (P<0.001). In addition, mean of PEF in the males was higher than the females in the morning (469.77 L/min, versus 355.94 L/min; independent t test, P<0.001), and also PEF mean of the morning and afternoon was higher in the males than females (404.6 L/min, versus 338.65 L/min, independent t test, P<0.001). Additionally, the variability level in the males and females was 8.39±6 and 8.47±4 L/min, respectively. There was a high correlation between the level of PEF variability and height (5.1). Meanwhile, a moderate correlation between PEF level and body mass index (BMI) was detected (1.47). There was not any correlation between the level of PEF and age. Conclusion: Based on our findings, PEF inter-individual variability depends on age, gender height, and BMI however, it is worthwhile that this PEF inter-individual variability to be measured just until 4 PM. All these variables were obtained under the range of 20%; however, relying on references, the variability of 20% is considered as normal.

Hypertension: Potential Player in Cardiovascular Disease Incidence in Preeclampsia

Preeclampsia (PE) is one of the complications, that threatens pregnant mothers during pregnancy. According to studies, it accounts for 3-7% of all pregnancies, and also is effective in preterm delivery. PE is the third leading cause of death in pregnant women. High blood pressure in PE can increase the risk of developing cardiovascular disease (CVD) in cited individuals, and is one of the leading causes of death in PE individuals. Atrial natriuretic peptide (ANP), Renin-Angiotensin system and nitric oxide (NO) are some of involved factors in regulating blood pressure. Therefore, by identifying the signaling pathways, that are used by these molecules to regulate and modulate blood pressure, appropriate treatment strategies can be provided to reduce blood pressure through target therapy in PE individuals; consequently, it can reduce CVD risk and mortality.

Ameliorative effects of pirfenidone in chronic kidney disease

Renal fibrosis is the hallmark of advanced chronic kidney disease (CKD), which is characterized by excessive accumulation of extracellular matrix (ECM) proteins and plays a central role in the pathogenesis and progression of CKD to end-stage renal disease (ESRD). The molecular and cellular substances of kidney fibrosis include growth factors, such as fibroblast growth factor (FGF), transforming growth factor beta (TGF-β) and platelet-derived growth factor (PDGF), alongside cytokines (like interleukin-1b) and metalloproteinases. Therefore, these factors can be evaluated as possible targets for anti-fibrotic agents. Among the mediators of fibrosis, TGF-β is the dominant facilitator of renal fibrosis that induces ECM construction and accumulation. Numerous studies have focused on the inhibition of TGF-β and its downstream targets for the treatment of renal disease. Abolition of TGF-β mRNA expression was found to be the mechanism of anti-fibrotic drug, pirfenidone, in the heart and kidneys of diabetic rats. Various investigations have shown the impact of pirfenidone in diminishing kidney fibrosis, with studies containing patients diagnosed with subtotal nephrectomy, diabetic kidney disease and unilateral ureteral obstruction (UUO), administered drugs such as cyclosporine, tacrolimus, doxorubicin and vanadate. Several therapeutic drugs for fibrosis reduce only one of the oxidative, inflammatory or profibrogenic markers, while pirfenidone targets all three of these markers and therefore, seems to be a particularly valuable drug.

Effect of low dose nebulized morphine on respiratory function improvement in mustard gas-exposed patients: A double-blind crossover clinical trial study

BACKGROUND

Mustard is one of the most destructive chemical gases used in chemical warfare. Several studies showed effectiveness of inhaled morphine as a secondary treatment for the improvement of dyspnea. Therefore, this study aimed at determining the efficacy of low dose inhaled morphine for respiratory function improvement in patients who were exposed to the mustard gas.

METHODS

This study was designed as a cross-over double-blinded clinical trial. Patients exposed to mustard gas were randomly assigned into two groups: 1) received 0.4 mg of morphine by inhalation and 2) received 5 ml of normal saline serum as a placebo in the same manner. After a washout period of one week, the first group received the placebo and the second group received morphine for 5 days. Spirometric indices, expiratory flow peak, exercise test, severity of dyspnea, and quality of life were evaluated as respiratory function parameters. Data analysis was done using SPSS software Version 16.

RESULTS

The mean maximum expiratory flow was significantly higher among cases who used morphine in comparison with the placebo group (p<0.05). Moreover, the severity of dyspnea, quality of life, and the frequency of coughing during the day were significantly improved among the recipients of morphine (p<0.05) while the spirometric indices and exercise tolerance tests were similar between the two groups (p>0.05), but the mean peak expiratory flow (PEFR) was significantly higher among the patients receiving morphine than the placebo patients (p<0.001).

CONCLUSION

The use of inhaled morphine had a significant positive effect on the respiratory system of people exposed to mustard gas. We can use low doses of inhaled morphine to improve the respiratory function of these patients as a secondary therapy.

Kidney complications following COVID-19 vaccination; a review of the literature

Objective: To review the reported cases of kidney injury following vaccination for coronavirus disease 2019 (COVID-19) with a focus on renal pathology. Methods: We searched for case reports of kidney complications after COVID-19 vaccine in PubMed. Results: A total of 36 articles including 49 case reports were reported. These included minimal change disease (n=17), IgA nephropathy (IgAN) (n=15), IgA nephritis/vasculitis (n=5), ANCA glomerulonephritis/vasculitis (n=5), anti-glomerular basement membrane (GBM) nephritis (n=2), and 1 case of each granulomatous vasculitis, acute tubulointerstitial nephritis, scleroderma renal crisis, IgG4-related disease nephritis, and primary membranous nephropathy (MN). Conclusion: We give an overview of the reported cases of post-COVID-19 renal complications. Further investigations of the underlying pathogenesis of post-COVID-19 vaccination renal adverse events are required, as prompt workup, diagnosis, and treatment of patients with renal complications may lead to complete remission, prevent kidney failure, and long-term complications such as end-stage renal disease (ESRD). However, these complications are overall extremely rare and the benefit of vaccination outweighs the potential risks.

Neurological manifestations of coronavirus infections: role of angiotensin-converting enzyme 2 in COVID-19

AIM OF THE STUDY

In December 2019, a highly pathogenic coronavirus called SARS-CoV-2 (formerly identified as 2019-nCoV) appeared in Wuhan, China, and has since been spreading rapidly around the world. we reviewed the neurological manifestations of this infection and the potential of ACE2 in the nervous system.

MATERIALS AND METHODS

Six databases (Medline, Scopus, Embase, Web of Science, WHO, and google scholar) were searched and screened by the authors for having appropriate information about covid-19. Finally, 72 studies were identified, summarized and reviewed.

RESULT

The most specific manifestation of SARS-CoV-2 patients is pulmonary distress, and several patients admitted to intensive care units were not able to breathe spontaneously. In addition, the SARS-CoV-2 outbreak has a significant effect on nervous systems and may even lead to serious neurological damage. The neuroinvasive pathobiology is still not fully elucidated and thus the effect of CoV infections on the nervous system needs to be explored. The spike protein of the virus and the angiotensin-converting enzyme 2 (ACE2) lead to the presence of both SARS-CoV and SARS-CoV-2 in the cells and, subsequently, decreased ACE2 expression.

CONCLUSION

The therapeutic possibilities of ACE2 antibody, ACE2-derived peptides, and small molecule blockers of ACE2 include a receptor-binding domain blocking approach. Hence, future studies of ACE2 may be very helpful in discovering a therapy for SARS-CoV-2.

COVID-19 and the kidney; mechanisms of tubular injury by SARS-CoV-2

Coronavirus disease 2019 (COVID-19) is an ongoing pandemic, reported to cause asymptomatic to severe disease and eventually death. Multi-organ failure and death in patients with severe COVID-19 is associated with increased release of pro-inflammatory cytokines into the blood stream. Renal impairment is reported in a significant proportion of COVID-19 patients and is associated with high mortality. Acute kidney injury (AKI) is multifactorial and involving overlapping pathogenic mechanisms. This review updates the reader of recent publications dealing with the mechanisms underlying AKI in patients with COVID-19. A full understanding of all the possible ways in which the system plays its role in AKI is still a matter of research. Further studies are warranted to better understand the causes of AKI in COVID-19 patients.

Critical complications of COVID-19: A descriptive meta-analysis study

The coronavirus disease 2019 (COVID-19) is a novel coronavirus infection that has rapidly spread worldwide, causing a pandemic. The main objective of this meta-analysis was to evaluate the prevalence of the most common symptoms and complications of COVID-19. All relevant studies on the clinical complications of COVID-19 have been identified by searching two web databases (i.e., PubMed and Scopus). Afterward, the relevant data were extracted from the selected studies, and then analyzed by the STATA (Version 14) random-effects model. The 30 studies selected for our meta-analysis covered 6,389 infected patients. The prevalence rates of the most common symptoms were as follows: fever: 84.30% (95% CI: 77.13-90.37; I2 = 97.74%), cough: 63.01% (95% CI: 57.63-68.23; I2 = 93.73%), dyspnea: 37.16% (95% CI: 27.31-47.57%; I2 = 98.32%), fatigue: 34.22% (95% CI: 26.29-42.62; I2 = 97.29%), and diarrhea: 11.47% (95% CI: 6.96-16.87; I2 = 95.58%). Moreover, the most prevalent complications were found to be acute respiratory distress syndrome (ARDS) with 33.15% (95% CI: 23.35-43.73; I2 = 98.56%), arrhythmia with 16.64% (95% CI: 9.34-25.5; I2 = 92.29%), acute cardiac injury with 15.68% (95% CI: 11.1-20.97; I2 = 92.45%), heart failure with 11.50% (95% CI: 3.45-22.83; I2 = 89.48%), and acute kidney injury (AKI) with 9.87% (95% CI: 6.18-14.25; I2 = 95.64%). In this study, we assessed the prevalence of the main clinical complications of COVID-19, and found that following respiratory complications, cardiac and renal complications are the most common clinical complications of COVID-19.

Strive for kidney health for everyone during COVID-19; the possible theme for the world kidney day 2021

Increasing awareness regarding CKD and self-care during COVID-19 pandemic has become the most important aspect for the nephrologists. Hence it is appropriate that the theme of the forthcoming World Kidney Day on 11 March 2021 should be "Strive for kidney health for everyone during COVID-19"

Covid-19 and kidney; a mini-review on current concepts and new data

In late December 2019, some cases of acute respiratory illness occurred in Wuhan, Hubei province, China that caused by a virus named "severe acute respiratory syndrome 2" (SARS-Cov2). More susceptible patients to this disease are elderly male patients since these patients with comorbid diseases are disposed to severe infection and more death. The most important comorbid diseases with COVID-19 pneumonia are hypertension, diabetes mellitus, cerebrovascular disease, chronic obstructive pulmonary disease, coronary heart disease. The most common symptoms of SARS-Cov2 infection are dyspnea, cough, fatigue, diarrhea and vomiting. High number of kidney disease in hospitalized patients with COVID-19 has been reported. Furthermore, a large group of patients with COVID-19 pneumonia had signs of kidney disease, with a high level of serum creatinine and blood urea nitrogen that could be justified with different pathophysiologies happened in COVID-19 pneumonia. However, massive differences were found in the prevalence of acute kidney injury (AKI) in patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 pneumonia, since various studies have shown that AKI correlates with higher mortality rate, upper morbidity and more severe cases of illness. Therefore, we should be informed about the pathophysiology of AKI in COVID-19 pneumonia to find the modalities to decrease the incidence of AKI and subsequent decrease mortality and morbidity of this disease.

Can urinary neutrophil gelatinase-associated lipocalin have a role in the early diagnosis of acute kidney injury after coronary artery bypass graft?

Introduction: The role of urinary neutrophil gelatinase-associated lipocalin (NGAL) as a prognostic biomarker in acute kidney injury (AKI) associated with coronary bypass graft has been suggested in some studies. However, the results have been inconclusive in different studies. Objectives: In the present research, we investigated the diagnostic and prognostic roles of NGAL in Iranian patients who developed AKI after coronary bypass surgery. Patients and Methods: This study was cross-sectional conducted on adult patients undergoing coronary artery bypass graft (CABG) surgery. Postoperative AKI was defined based on the RIFLE (risk, injury, failure, loss and end-stage kidney disease) criteria. Patients were divided into AKI and non-AKI groups. The urinary NGAL and serum creatinine levels were measured at different times after surgery. Results: Out of 29 patients, men constituted 75.9% of cases. Mean age of the patients was 61.4±7.7 years old and the mean duration of surgery was 4.9±0.6 hours. Based on serum creatinine, AKI was diagnosed in 37.9%, 17.25%, and 13.8% of patients at first, second, and third day post-surgery, respectively. The urine NGAL increased by 48.35% and 34.5% at 2 and 6 hours after surgery, respectively. However, there was no significant association between the urinary NGAL level and the incidence of post-surgery AKI. Conclusion: This study showed that urinary NGAL was inapplicable to independently diagnose or predict the outcome of transient AKI associated with CABG.

Acute and delayed nephropathy due to methamphetamine abuse

Methamphetamine is a highly addictive drug that acts as a stimulant for the central nervous system. It increases alertness and physical activity but can cause cardiac dysrhythmias, hypertension, hallucinations and violent behavior. The excretion rate of methamphetamine by the kidney can be seriously altered by urinary pH. Methamphetamine is a weak base, consequently, the proportion of the excreted amount of unchanged drug can vary from as little as 2% in alkaline (pH ≥8.0) to 76% in acidic urine (pH ≤5.0). Methamphetamine is metabolized by hepatic metabolism and renal excretion via cytochrome P450 2D6 (CYP2D6). The effects of methamphetamine on the kidneys can be divided into the following sub-groups: vascular effects, non-traumatic rhabdomyolysis and direct nephrotoxicity. Additionally, methamphetamine directly stimulates the release of ET-1, a potent vasoconstrictor. ET-1 stimulates vasoconstriction, inflammation and fibrosis in kidney, thus promoting hypertension, atherosclerosis and chronic kidney disease.

Administration of vitamin D to ameliorate dyspnea of chronic obstructive pulmonary disease patients: a randomized controlled trial

Introduction: As one of the most common causes of human morbidity and mortality, chronic obstructive pulmonary disease (COPD) affects millions around the world. Some evidences have already considered about association between serum levels of vitamin D and COPD. Objectives: This study was aimed to evaluate the effects of vitamin D supplementation on COPD improvement. Patients and Methods: This study was designed as a randomized controlled trial. Forty COPD patients with vitamin D deficiency were enrolled into two groups; cases group who administered vitamin D and control group who received placebo. The severity of dyspnea and spirometric indices were analyzed in both groups. Values were presented as mean and standard deviation (SD) and differences were considered significant at the level of P<0.05. Results: Spirometric indices did not show significant differences before and after vitamin D administration (P>0.05). Dyspnea severity was significantly improved after receiving vitamin D supplementation in comparison with placebo consumption (P=0.03). Conclusion: Spirometric indices were not affected during vitamin D supplementation therapy but it showed a significantly positive effect on the curing of dyspnea. Therefore, adjuvant therapy of COPD using vitamin D supplementation is recommended to better handling of dyspnea in COPD cases.

Association between abnormal serum free light chains ratio and known prognostic factors in lymphoma; a nephrology viewpoint

Introduction: The serum immunoglobulin free light chain (FLC) assay quantities of free kappa (κ) and lambda (λ) light chains. This assay has prognostic value in plasma cell proliferative disorders. There are limited data on serum FLC in B-cell malignancies.

Objectives: The aim of this study was to compare the known prognostic factors in non-Hodgkin’s lymphoma of the type B-cell and Hodgkin disease with an abnormal secretion amount of light chains in these lymphomas.

Patients and Methods: The association of pretreatment FLC and FLC ratio (κ:λ) with previously known prognostic factors for lymphoma such as the international prognostic index (IPI) and B symptoms were evaluated in 50 patients with Hodgkin’s and non-Hodgkin’s lymphoma. IPI is a prognostic score given based on the clinical variables including age, disease stage, serum LDH and extra-nodal involvement. Elevated FLC and an abnormal κ:λ ratio was defined based on the previous publications.

Results: The prevalence of abnormal FLC ratio was 38% in all patients and 40.9% in patients with diffuse large B-cell lymphoma. Abnormal FLC ratio was significantly associated with IPI (P=0.04) and B symptoms (P=0.02) in both groups of the patients with Hodgkin’s and non-Hodgkin’s lymphoma. The stage of the disease in Hodgkin’s lymphoma patients showed a significant relationship with the abnormal FLC ratio (P=0.04). Presence of the B symptoms in patients with Hodgkin’s lymphoma had a modest but not statistically significant association with the abnormal FLC ratio (P=0.07).

Conclusion: Abnormal FLC ratio as a new potent prognostic biomarker has a significant association with IPI which is the most common clinical tool used to predict outcome in lymphoma patients. Since there is a need for developing a reliable and quantitative prognostic biomarker for lymphoma, evaluation of the independent effect of the abnormal serum FLC ratio is suggested to be considered in future prospective studies. The result of these studies will also be useful for nephrologists, while serum immunoglobulin FLC is capable to damage kidney.

Bioimpacts of dialyzer variety on phosphorus level in Iranian hemodialysis patients

INTRODUCTION

Cardiovascular events are the major cause of death in patients with chronic renal failure. About half of dialysis patients because of reduced phosphorus clearance have hyperphosphatemia. Hyperphosphatemia and following secondary hyperparathyroidism lead to some cardiovascular changes. Hemodialysis (HD) partly removes phosphorus during each dialysis session.

OBJECTIVES

Presented study was designed to evaluate dialyzer variation effect on phosphorus level as a prognostic factor after dialysis using.

MATERIALS AND METHODS

Six kinds of dialyzer were used for dialysis; low flux (LF) dialyzer (F7 and F8), high flux (HF) dialyzer (F70 and F80) and finally hollow-fiber dialyzers including polyethersulfone (PES) 130 HF and polysulfone (PS) 13 LF. Fifty-seven patients were divided into 6 matched groups included three groups of 10 people and 3 groups of 9 persons in groups: A (F70), B (F80), C (F7), D (F8), E (PES 130 HF) and F (PS 13 LF). Patients were treated for one month with these dialyzers. At the end of the month, blood samples were taken again for phosphorus level before dialysis handling.

RESULTS

The mean pre-dialysis serum phosphorus was 5.03, 5.4, 5.2, 4.6, 4.95 and 5.1 mg/dl and the mean phosphorus was 5.43, 5.01, 4.9, 4.18, 4.17 and 5.3 mg/dl after one month of dialysis, respectively in groups A to F without any statistically differences between pre- and after one month dialysis values respectively.

DISCUSSION

The findings indicate dialyzer type in the control of serum phosphorus has not been effective in the short-term HD. We suggest a study with more duration time.

Role of plasma neutrophil gelatinase-associated lipocalin as an emerging biomarker of acute renal failure following kidney transplantation and its correlation with plasma creatinine

Introduction: Graft function early after kidney transplantation is an important parameter in determining the outcome of operation. Urinary and plasma neutrophil gelatinase-associated lipocalin (NGAL), a member of the lipocalin protein family, has been advocated as a sensitive, early biomarker for predicting early renal graft after transplantation. The functions of NGAL appears to be expressed in stress conditions and in tissues undergoing involution. It rapidly accumulates in the kidney tubules and urine after nephrotoxic and ischemic insults.

Objectives: This study aimed to examine the prognostic role of NGAL early after renal transplantation.

Patients and Methods: A total of 37 kidney recipients were enrolled from a teaching centre in Tabriz within a 6-month period of time. Plasma NGAL was measured immediately before and at 6 and 12 hours post-transplantation. Changes of serum creatinine were documented daily within the first week post-operation. Acute kidney injury (AKI)/graft rejection during the first week after transplantation was the outcome variable.

Results: There were 22 males (59.5%) and 15 females (40.5%) with the mean age of 34.93 ± 14.97 years (range: 12-59) in the study group. AKI/graft rejection developed in 12 patients (32.4%). The mean post-transplantation plasma NGAL levels and serum creatinine at all time points were significantly higher in patients with AKI/graft rejection. The best prognostic role was found for plasma NGAL at 12 hours (sensitivity = 100%, specificity = 92%; cut-off value = 309 ng/ml), far better than the prognostic accuracy of corresponding serum creatinine (sensitivity = 66.7%, specificity = 61.9%).

Conclusion: Plasma NGAL, particularly 12 hours after transplantation, is a very sensitive and specific biomarker for predicting acute renal injury.

Evaluation of the protective effect of N-acetylcysteine on contrast media nephropathy

INTRODUCTION

Intravenous contrast agents can cause acute decline in kidney function, especially in patients with risk factors.

OBJECTIVES

In this study, we aimed to examine the ameliorative effect N-acetylcysteine (NAC) to reduce the incidence of contrast nephropathy.

PATIENTS AND METHODS

This study was a prospective, randomized, double-blind clinical trial on 150 patients who underwent coronary angiography. The study was carried out on patients undergoing coronary angiography. Patients were randomly assigned into 2 groups of intervention group and control subjects. Intervention group took NAC 600 mg orally twice a day. It was administered one day before angiography and continued until the second day after angiography. Control subjects received saline only. Serum creatinine was measured before and three days after coronary angiography.

RESULTS

There was no significant difference between intervention and control groups at baseline (P > 0.05). However, there was a significant decline in creatinine level among NAC patients (P = 0.001). Saline group had significantly higher proportion of nephropathy cases than NAC patients Conclusion: We found that the consumption of NAC is useful for contrast induced nephropathy (CIN) prevention.

Incidence of BK Virus Nephropathy (BKVN) in Renal Transplant Recipients

BACKGROUND

BK virus nephropathy (BKVN) is one of the complications of renal transplantation that causes graft loss in renal transplant recipients.

OBJECTIVE

To determine the incidence of BKVN after renal transplantation in Hasheminejad Hospital, Tehran, Iran.

METHODS

In this analytical cross-sectional study, we evaluated 31 consecutive kidney transplant recipients (21 men and 10 women) for BK and JC viral infections and BKVN during one year after transplantation, Urine of patients was tested for the presence of decoy cells and DNA of BK and JC virus by PCR. The serum load of BK and JC virus was assessed in patients 3, 6, 9, and 12 months after transplantation. Renal biopsy was performed in presence of allograft dysfunction or viral load >10(7) copies/mL.

RESULTS

The prevalences of decoy cells and BK and JC viral DNA in urine of patients were 16%, 29%, and 23%, respectively. BK or JC virus was found in 45% of the urine samples. During one year follow-up, no cases of BKVN was observed.

CONCLUSION

Despite a high rate of BK viral infection, no one with BKVN was observed in our kidney transplant recipients. Therefore, screening of all transplant recipients for BKVN is not recommended.