Desmopressin Acetate in Percutaneous Ultrasound-Guided Native Kidney Biopsy in Patients with Reduced Kidney Function: A Double-Blind Randomized Controlled Trial.

INTRODUCTION: Bleeding events are the most common complications after kidney biopsy. This study aims to evaluate the effect of desmopressin administration on bleeding complication, in native kidney biopsy candidates with reduced kidney function. METHODS: This double-blind randomized clinical trial enrolled 18 to 80 years old patients with 15 < eGFR < 90 mL/min/ 1.73m² from July 2017 to August 2020. Patients were randomly assigned to receive either 3 µg/kg of intranasal desmopressin acetate or 1 mL/kg of intranasal sodium chloride 0.65%, one hour before ultrasound-guided, percutaneous native kidney biopsy. The primary outcome was the post-biopsy bleeding complications, and secondary outcomes were the volume of perirenal hematoma, and changes of post-biopsy hemoglobin and hematocrit level, plasma sodium and blood pressure (Clinical Trial Registration ID: IRCT20090701002112N3). RESULTS: A total of 120 patients (58 men and 62 women), 60 patients in each group, were analyzed. The mean age and eGFR of the patients were 45.29 ± 15.95 years and 51.77 ± 18.02 ml/min/ 1.73m², respectively. Desmopressin administration significantly decreased post-biopsy perirenal hematoma compared to placebo (7/60 [11.6%]) vs. 33/60 [40%]; P < .05), and the hematoma volume was significantly smaller in the desmopressin group, in case of hematoma formation (2.31 ± 1.17 vs. 7.72 ± 5.45 mm³, P < .05). CONCLUSION: Desmopressin administration before kidney biopsy is a safe and effective strategy to prevent bleeding complications. Considering absolute risk reduction of about 28%, the number needed to treat is about 4 procedures. We recommend considering desmopressin administration before percutaneous native kidney biopsy.  DOI: 10.52547/ijkd.6966.

Anti-proteinuria effect of active vitamin D in patients with type 2 diabetic nephropathy.

Introduction: Proteinuria is a common complication in patients with type 2 diabetic nephropathy (DN). The aim of this study was to evaluate the anti-proteinuria effect of active vitamin D in patients with type 2 DN. Methods: A double-blind randomized clinical trial study was conducted on 42 DN patients selected by convenience sampling method. After selecting patients based on inclusion criteria, they were randomly divided into control and intervention groups. Patients in the intervention group received 0.25 mg of active vitamin D per day for 12 weeks. The variables evaluated in the patients on the first day of the intervention included fasting blood sugar (FBS), calcium, phosphorus, creatinine, glomerular filtration rate (GFR), systolic and diastolic blood pressure, and proteinuria. These variables were also evaluated at the end of the first, second, and third month of intervention. Data were collected and analyzed in Statistical Package for Social Sciences software version 22. Results: Around 52.5% of the patients participating in this study were male and 47.5% were female. The mean age of the patients was 55.52 ± 6.58 years. The results of repeated measures analysis showed that active vitamin D significantly reduced proteinuria (P = 0.000) in patients in the intervention group. The changes in FBS (P = 0.235), calcium (P = 0.393), phosphorus (P = 0.694), creatinine (P = 0.232), GFR (P = 0.347), systolic blood pressure (P = 0.615), and diastolic blood pressure (P = 0.115) were not significant in patients in the intervention group. Conclusion: Prescription of active vitamin D can significantly reduce the incidence of proteinuria in patients with DN.

Hypertension and microalbuminuria 5 years after pregnancies complicated by pre-eclampsia.

INTRODUCTION: Pre-eclampsia is part of a spectrum of conditions known as the hypertensive disorders of pregnancy. It is claimed that pregnant women with pre-eclampsia or eclampsia are at increased risk of kidney disease and hypertension later in life. We investigated whether Iranian women with a history of pre-eclampsia had higher rates of hypertension and microalbuminuria compared with women with uneventful pregnancy. MATERIALS AND METHODS: Medical records of pregnancies delivered at two hospitals in Ahvaz, between March 2001 and February 2003 were reviewed. Thirty-five pre-eclamptic women were identified and contacted for assessment of hypertension and albuminuria. They were compared with 35 women matched for year of delivery and age who had a pregnancy uncomplicated by hypertension. RESULTS: The mean follow-up from the index pregnancy was 5.7 years (range, 5.2 to 7.3 years). While only 1 woman (2.9%) in the control group was currently hypertensive, 28.6% of those with a history of pre-eclampsia (n = 10) were hypertensive (P = .003; relative risk, 10.0; 95% confidence interval, 1.35 to 74.00), 7 of whom were receiving antihypertensive medication at the time of evaluation. Among the formerly pre-eclamptic women, 7 had albuminuria (20.0%), whereas none of the controls were albuminuric (P < .001). Microalbuminuria was present in all hypertensive women in the pre-eclampsia group, but not in the only women in the control group with hypertension. CONCLUSIONS: We showed that in patients with a history of pre-eclampsia, there are increased risks of hypertension and microalbuminuria in the long term after pregnancy.

Alteration of panel-reactive antibodies following treatment with either atorvastatin or low-dose mycophenolate mofetil in sensitized hemodialysis patients.

INTRODUCTION: Both atorvastatin and mycophenolate mofetil (MMF) have been used for panel reactive antibodies (PRA) reduction in transplant candidates. The purpose of this study was to compare the effect of low-dose MMF and atorvastatin on PRA in sensitized hemodialysis patients waiting for kidney transplantation. MATERIALS AND METHODS: A total of 40 adult patients with end-stage renal disease who were highly sensitized to human leukocyte antigens (PRA > 40%) were enrolled and randomly assigned into atorvastatin or low-dose MMF groups. All of the patients received the treatments for 2 months. The PRA status was determined at the end of the 1st and 2nd month. RESULTS: Forty percent of the patients in the atorvastatin group compared with 5% in the low-dose MMF group showed complete response, defined as a minimum 50% reduction in PRA (P = .02). Reduction of PRA in the atorvastatin group was significantly higher than that in the low-dose MMF group (P = .01). No major infectious or other complications occurred in our patients. CONCLUSIONS: Atorvastatin has a significant effect on lowering of PRA in sensitized hemodialysis patients waiting for kidney transplantation. In addition, a short course of low-dose MMF is safe in ESRD patients; however, it has no effect on reduction of PRA.