The Effects of Coenzyme Q10 on Contrast-Induced Acute Kidney Injury in Type 2 Diabetes: A Randomized Clinical Trial.

Contrast-induced acute kidney injury (CI-AKI) is a frequent challenge following the injection of contrast media and its subsequent oxidative stress. The aim of the present study was to evaluate the preventive effects of coenzyme Q10 (Q10), as a mitochondrial-targeted antioxidant in CI-AKI in diabetic patients, who account for a large proportion of angiographic cases. A total of 118 diabetic patients were randomly assigned to receive 120 mg of oral coenzyme Q10 (Q10 group) or placebo (Placebo group) for four days, starting 24 hours before contrast media injection. Blood urea nitrogen (BUN), serum and urinary creatinine, estimated glomerular filtration rate (eGFR), urinary malondialdehyde (UMDA), urinary total antioxidant capacity (UTAC), and urinary mitochondrial to nuclearDNA ratios (mtDNA/nDNA ratio) were evaluated before and after the treatment period. Urine sediments were also evaluated to report the urine microscopy score (UMS).The levels of BUN, serum and urine creatinine, and UMS were similar in the Q10 and placebo groups. EGFR was lower in the Q10 group before the treatment (p=0.013) but not after. The urinary mtDNA/nDNA ratio was 3.05±1.68 and 3.69±2.58 in placebo and Q10 groups, but UTAC was found to be lower in Q10 both before (p=0.006) and after the treatment (p<0.001). The incidence of CI-AKI was 14.40% and the mtDNA/nNDA ratio was similar between CI-AKI and non-CI-AKI patients. In conclusion, Q10 treatment shows no favorable effect on prevention of CI-AKI or a urinary mtDNA/nDNA ratio among diabetic patients.

Design and Fabrication of a Gas Sensor Based on a Polypyrrole/Silver Nanoparticle Film for the Detection of Ammonia in Exhaled Breath of COVID-19 Patients Suffering from Acute Kidney Injury.

One of the serious complications of COVID-19 is acute kidney injury (AKI), leading to a decrease in kidney function and even death. The concentration of ammonia (NH3) in the exhaled breath (EB) of COVID-19 patients suffering from AKI symptoms will be significantly increased. In this work, the detection of breath NH3 was performed at gold interdigital electrodes modified with a soluble polypyrrole microparticle and silver nanoparticle film (Au-IDEs/S-PPyMPs/AgNPs) as a noninvasive chemiresistor gas sensor. The response behavior of unmodified and modified gas sensors toward NH3 and other interfering compounds was studied. The Au-IDEs/S-PPyMPs/AgNPs exhibited NH3 detection in the linear dynamic range of 1.00-19.23 ppm, with a limit of detection of 0.12 ppm. Finally, the fabricated gas sensor was used to monitor the NH3 concentration in the EB of COVID-19 patients suffering from AKI symptoms. For this purpose, the gas sensor was validated in 19 EB samples (seven COVID-19-positive patients, four COVID-19-negative patients, and eight post-COVID-19 patients). The gas sensor was directly exposed to the EB samples, followed by recording the changes in electrical resistance via a low-cost digital multimeter. The sensing mechanism was explained as the interaction between breath NH3 and sensing materials. The breath NH3 concentrations have a desirable correlation (R2 = 0.8463) with the estimated glomerular filtration rate (eGFR) values in COVID-19-positive patients. The fabricated gas sensor can distinguish COVID-19-positive patients suffering from AKI symptoms from COVID-19-negative patients and post-COVID-19 patients. The present work can pave the way for the development of a simple and efficient analytical approach for COVID-19 patients with AKI without the need for sample pretreatment.

Protective Effect of the Hydroalcoholic Extract of Pelargonium Graveolens L. on Rats with Acetaminophen- Induced Nephrotoxicity.

INTRODUCTION: Geranium has various antioxidant, anti-inflammatory, and anti-microbial effects. Prescribing glutathione probably enhances the protective mechanisms of nephrons against oxidative stresses. This study aimed to evaluate the protective effect of geranium on acetaminophen-induced nephrotoxic rats. METHODS: In the present study, 70 mice were divided into seven groups. In five groups (T1, T2, T3, T4, and T5), different doses of geranium were given by gavage to the mice for seven days, then on the 8th day, a high dose of acetaminophen was administered intraperitoneally. Group T5 only received geranium extract. The control group received neither acetaminophen nor the extract while the last group received only a toxic dose of acetaminophen. Twenty-four hours after the last drug administration, blood samples were taken to check the levels of uric acid, blood nitrogen, and creatinine. The data were analyzed in SPSS version 25. To investigate the between-group factors' effects, one-way ANOVA with Tukey's post hoc test was performed at the alpha level of < 0.05. RESULTS: The differences between the levels of blood creatinine, urea, and uric acid were significant (P < .001) among the groups. The mean blood urea for groups T3 and T4 were similar, and they had a significant difference in comparison with the control group (P < .05). The mean creatinine levels were similar between T4, T5, and the control groups and were significantly different from the other groups (P < .05). Blood uric acid for groups T1 and T2 were similar to Group B and higher than the other groups (P < .05). CONCLUSION: The results showed that by strengthening cell protection mechanisms against oxidative stress, geranium extract reduces the toxic effects of acetaminophen on mice's kidney function and thus ameliorates the damage. As a result, the geranium extract has no adverse effects on kidney function.  DOI: 10.52547/ijkd.6679.

The Effect of Ostrich Oil as a Complementary Medicine on the Severity of Pruritus and Quality of Life in Hemodialysis Patients.

INTRODUCTION: Pruritus is one of the most common problems in a uremic syndrome that reduces the quality of life due to the constant unpleasant feeling. The purpose of this study was to investigate the effect of ostrich oil massage on the severity of pruritus and quality of life in hemodialysis patients. METHODS: In this study, 68 hemodialysis patients with pruritus were selected based on the available sampling method. The intervention group used 1 mL ostrich oil on the pruritus area for 10 min each night for 1 month. The control group received a placebo massage. Pruritus severity questionnaire-based itch severity scale and quality of life questionnaire were completed, respectively, at the end of each week and at the end of the period. Statistical analysis was done using SPSS software version 23 and applying on independent t test, paired t test, and analysis of covariance. RESULTS: During the first and second weeks after the treatment, there was no statistical difference between the mean scores of pruritus severity in both groups (p > 0.05); however, in the third and fourth weeks after the treatment, the mean severity level of pruritus in the ostrich oil group was lower than in the placebo group, and these differences were statistically significant between the two groups (p < 0.05). There was no significant difference in quality of life between two groups of ostrich and placebo. CONCLUSION: The use of ostrich oil was effective in reducing pruritus in hemodialysis patients. This method can be proposed as a complementary method for relieving pruritus in hemodialysis patients.

Evaluation of Efficacy of Mirtazapine on Pruritus and Serum Histamine and Serotonin Levels in Patients Undergoing Hemodialysis: A Before-After Pilot Clinical Trial.

BACKGROUND: Although chronic kidney disease-associated pruritus (CKD-aP) remains a frequent and frustrating symptom in patients with advanced kidney diseases, its optimal treatments are not well defined. Based on its mechanism of action, as a histamine-1 (H1), 5-(hydroxytryptamine) HT2, and 5HT3-receptor blocker, mirtazapine may be effective in the treatment of CKD-aP. Hence, this study aimed to investigate the efficacy of mirtazapine for the treatment of pruritus in patients undergoing hemodialysis (HD). METHODS: A before-after clinical trial was conducted from September 2018 until March 2019, on 30 HD-patients that had been referred to the HD ward of a tertiary hospital, in Hamadan, Iran. After the 2-week washout period, mirtazapine was administered with a dosage of 15 mg/day for an additional 2 weeks. At baseline and at each dialysis session, the effects of the mirtazapine on the pruritus severity based on the visual analogue scale (VAS) and degree of sleep interference resulting from the pruritus were asked and recorded. Additionally, at the baseline and the end of 2 weeks of treatment, the serum histamine and serotonin levels, as the main chemical pruritogens evoking pruritus symptoms, were also determined. RESULTS: Twenty-seven patients completed the entire course of the study. Based on the general linear model analysis, a progressive decline in the mean VAS score was observed over time during the study. The mean VAS score decreased from 8.48 ± 1.01 at baseline to 1.04 ±0.79 at the end of treatment (P-value<0.001). Similarly, the mean sleep interference scores were also significantly improved throughout treatment (decreased from 8.07±1.43 to 2.81± 0.74; P-value<0.001). Further, at the end of the treatment, a noticeable decrement in the serum histamine level was also seen (P-value = 0.006). The drug was acceptably well-tolerated and a majority of the patients were satisfied with this treatment. CONCLUSION: This pilot study suggests that mirtazapine may be an effective treatment option for the management of CKD-aP. However, further studies would be needed to confirm these results.

Effect of mirtazapine on pruritus in patients on hemodialysis: a cross-over pilot study.

BACKGROUND: Uremic pruritus (UP) is a highly prevalent and disturbing problem in patients with advanced chronic kidney disease (CKD); however, treatment of UP is largely unsatisfactory. The present study was designed to investigate the effectiveness of mirtazapine, an atypical antidepressant agent with potent antagonistic activity against serotonin (5HT2, 5HT3) and histamine (H1) receptors, in the treatment of pruritus in hemodialysis (HD) patients. METHODS: An 8-week long, prospective, open-label, and cross-over randomized clinical trial study was conducted on 77 HD patients with chronic pruritus. After a 2-week washout period, eligible patients were randomly assigned either to the mirtazapine (15 mg per day) or gabapentin (100 per day) for 2 weeks. Following 2 weeks washout period, subjects crossed over to the other treatment arm for 2 more weeks. The severity of pruritus was measured seven times during each treatment period using the visual analogue scale (VAS). Furthermore, at the end of the study, patients also were blindly asked which treatment (first or last in the sequential course of the study) they preferred. RESULTS: Sixty-one patients completed two treatment periods of the study. Although, compared to baseline, both gabapentin and mirtazapine treatment resulting in significant improvement in VAS scores, decreasing in pruritus severity was significantly greater in the mirtazapine treatment period compared with the gabapentin treatment period (P < 0.001). Furthermore, although side effects such as drowsiness and dry mouth more reported in the mirtazapine treatment period, overall higher percentage of the study patients preferred mirtazapine over gabapentin for the treatment of their pruritus symptoms. CONCLUSIONS: Although preliminary, our study provides evidence that mirtazapine can be an effective therapy for UP in patients who are on maintenance HD. However, further studies would be necessary to confirm effectiveness as well as the safety of mirtazapine in the long-term management of chronic pruritus.

Access Recirculation in Permanent Catheters of Hemodialysis Patients.

Treatment for end stage renal disease patients is based on dialysis; however, the presence of access recirculation (AR) decreases dialysis efficiency and adequacy. This study was conducted to determine the recirculation rate in dialysis patients undergoing hemodialysis through using a permanent catheter. 60 patients including 23 males and 37 females were enrolled. Mean age of the participants was 57.66 (± 14.08) years. Mean AR in the subjects was 9.36%, and 16 (27%) of patients had mean AR above 10%. Moreover, there was a significant correlation between AR and catheter longevity (P < .001). It is suggested to limit the use of permanent catheters to specific cases and not to use them in place of arteriovenous fistulas.

Comparison of safety and efficacy of general and spinal anesthesia in kidney transplantation: Evaluation of the peri-operative outcome.

General anesthesia is a routine anesthetic technique for kidney transplantation. This study evaluated and compared the peri-operative hemodynamic, cardiopulmonary and general condition status in patients in whom spinal anesthesia (SA) or general anesthesia (GA) was used for kidney transplantation. A prospective study was carried out on 49 consecutive patients who underwent kidney transplantation with either GA (19 patients, mean age 37.53 ± 11.78 years) or SA (30 patients, mean age 42.17 ± 14.89 years), without any selection bias. One obese patient with a body mass index of 32.52 kg/m 2 died 22 days after transplantation in the GA group. One other patient, who developed severe nausea and vomiting, was changed from SA to GA. There were no statistical differences in gender, mean age, body mass index and hemodynamic and cardiopulmonary status between the two groups. Time to post-operative diet tolerance, defecation, ambulation and adequate urination were significantly better in the SA group. The mean operation time was 264.32 ± 18.91 and 233 ± 15.12 min in the GA and SA groups, respectively. Brisk diuresis was seen in all patients except one in the SA group. Our study suggests that kidney transplantation under SA is feasible and safe, particularly for patients who cannot receive GA.

High-flux and low-flux membranes: efficacy in hemodialysis.

BACKGROUND: Inadequacy of dialysis is one of the main causes of death in hemodialysis patients. Some studies have suggested that high-flux membrane improves the removal of moderate-sized molecules while other studies indicate no significant effect on them. OBJECTIVES: This study aimed to investigate the dialysis efficacy of low-flux versus high-flux membranes in hemodialysis patients. PATIENTS AND METHODS: Forty hemodialysis patients participated in this cross-over clinical trial. Two sessions of low-flux and high-flux membrane dialysis were performed consecutively, in the first and second stage of the trial. In both stages, blood samples before and after the dialysis were taken and sent to the laboratory for assessment. Blood urea nitrogen (BUN), KT/V and the urea reduction ratio (URR) indexes were used to determine dialysis efficacy. Data were analyzed using t test and paired t test. RESULTS: The mean KT/V was 1.27 ± 0.28 in high-flux and 1.10 ± 0.32 in low-flux membrane which, these differences were statistically significant (P = 0.017). The mean of URR was 0.65 ± 0.09 in high-flux and 0.61 ± 0.14 in low-flux membrane, which these differences were not statistically significant (P = 0.221). CONCLUSIONS: The high-flux membrane had better dialysis adequacy, so we suggest using high-flux membrane in hemodialysis centers.

The prevalence of anticardiolipin antibody in patients with systemic lupus erythematosus and its association with clinical manifestations.

The central immunological disturbance in systemic lupus erythematosus (SLE) is autoantibody production. Some of these antibodies affecting components of the cell nucleus are the major characteristics of SLE. The present study was aimed to assess importance of anticardiolipin (ACL) antibody and its association with clinical state in SLE patients. A cross sectional study was performed on 100 patients with SLE referred to rheumatology outpatient clinic in Ekbatan hospital in Hamadan (Iran) between 2007 and 2008. Serum samples were extracted and screened for IgG and IgM using an ACL enzyme-linked immunosorbent assay. Up to 36% of patients were positive for ACL antibody that was more frequent in women than men (39.8% versus 8.3%). No association was revealed between ACL antibody and age. Clinical manifestations of antiphospholipid antibody syndrome were observed in 23.0% of patients that was more prevalent in ACL positive group compared with ACL negative group (41.7% versus 125%). The prevalence of other manifestations including pregnancy-related disorders (recurrent abortion), central nervous system defects, and deep vein thrombosis was 33.3%, 25.0%, and 30.6% in ACL positive group and was 9.4%, 7.8%, and 7.8% in ACL negative group that all were more frequent in the former group. The prevalence of thrombocytopenia was also higher in ACL positive group than another group (22.2% versus 15.6%). Among ACL positive patients with clinical manifestations of antiphospholipid antibody syndrome, 86.6% had medium to high titer of ACL. Our study emphasized value of (ACL) antibody to assess clinical status in SLE patients.

Reflex anuria affecting both kidneys following hysterectomy.

In situations when there is unilateral ureteral obstruction, the contralateral kidney retains its normal function. In rare instances however, it has been reported that unilateral ureteral obstruction can lead to reflex anuria (RA) and acute renal failure (ARF). Even more unusually, RA with ARF can occur without organic obstruction due to ureteric manipulation during pelvic surgery. We report a 78- year-old woman, who underwent hysterectomy because of endometrial carcinoma. She developed ARF evidenced by anuria of 120-hours duration, and gradual rise of serum creatinine levels to 11.8 mg/dL on the fifth day after hysterectomy. Ultrasound study of the urinary tract revealed bilateral moderate hydronephrosis. Detailed evaluation did not reveal any organic obstruction. She was managed with hemodialysis, control of hypertension and correction of fluid and electrolyte imbalances. By the sixth day, diuresis was established, and the blood urea and serum creatinine levels decreased to normal by the sixteenth day. The patient was finally discharged on the eighteenth day. Our case suggests that urologists and nephrologists should consider RA as one of the causes of anuria and ARF.

The effectiveness of combined treatment with methylprednisolone and cyclophosphamide in oral paraquat poisoning.

BACKGROUND: Paraquat is a bipyridil herbicide and in appropriate and careful usage, will not be health threatening. Most adult cases of intoxication are due to suicidal attempts rather than accidental exposure. Therapeutic response has been reported to be appropriate with high doses of cyclophosphamide and glucocorticoids and survival is reported to be approximately 75%. So, this study was designed to evaluate the effects of combined treatment with cyclophosphamide and glucocorticoids in patients with paraquat poisoning. METHODS: During a two-year period 45 patients with paraquat poisoning were admitted to Sina Hospital, Hamadan, Iran, of whom 20 had moderate to severe intoxication. Eleven patients (group 1) received conventional treatment and nine patients (group 2) received conventional treatment plus intravenous infusions of cyclophosphamide 15 mg/kg daily for two days, methylprednisolone one gram daily for three days, and mesna 15 mg/kg for four days. RESULTS: The mean age+/-SD in group 1 was 25+/-10 years and in group 2 was 26+/-10 years. In group 1 three patients were females and eight patients were males. In group 2 one patient was female and eight patients were males. There were no differences between the groups in the time elapsed from ingestion to presentation at hospital or in the beginning of hemodialysis. The mortality rate in group 1 was 81.8% and in group 2 was 33.3% (P< 0.05). All fatalities caused by acute respiratory distress syndrome. CONCLUSION: Pulse therapy with cyclophosphamide and methylprednisolone may be effective in preventing respiratory failure and reducing mortality in patients with moderate to severe paraquat poisoning.

The effects of Continuous Care Model on depression, anxiety, and stress in patients on hemodialysis.

This quasi-experimental study was carried out to determine the effects of the Continuous Care Model on stress, anxiety, and depression in patients on hemodialysis in Hamedan, Iran in 2005. Thirty-eight patients were selected randomly and the Depression Anxiety Stress Scale (DASS-21) was used for data collection. Data analysis showed a significant relationship between applying the Continuous Care Model and DASS-21 scores. According to the findings, applying this care model can improve the lives of patients on hemodialysis.