Is CKD Screening Program Necessary in Developing Countries?

INTRODUCTION: The prevalence of congenital anomaly of kidney and urinary tract (CAKUT) and related chronic kidney disease (CKD) may be increased in countries with higher rate of consanguineous marriage. Therefore, we evaluated the prevalence of CKD by biochemical and kidney ultrasound measurements in the firstgrade pupils. METHODS: This cross -sectional study was carried on children aged 6 to 7 years. Urine analysis, serum creatinine, urine microalbumin to creatinine ratio and kidney ultrasound have been evaluated for participants. RESULTS: 653 children were recruited to the study. Stage 1 and stage 2 systolic hypertension have been found in 6.5 and 1%, respectively. The percentage of stage 1 and stage 2 diastolic hypertension were 1.3 and 0.3%, respectively. Both weight Z-score and waist Z-score had positive correlation with systolic and diastolic blood pressure. Microalbuminuria (in 2.5%) did not have any correlation with the following factors: hypertension, body mass index, microscopic hematuria, glomerular filtration rate, kidney sonographic abnormalities or kidney parenchymal thickness and family history of kidney transplantation. GFR less than 90 mL/ min /1.73 m2 has been detected in 1.8% of the students. Only 1.7% had urine RBC more than 5 in each high-power field (hpf). Approximately 1.5% had anatomical abnormality of kidney and urinary tract (hydronephrosis or hydroureter). CONCLUSION: Considering the higher prevalence of elevated blood pressure and microalbuminuria in Iranian children, a CKD screening program based on evaluating microalbuminuria and blood pressure measurement is needed. However, irrespective of high prevalence of consanguineous marriage in Iran, using kidney ultrasound as a screening tool has not been recommended.  DOI: 10.52547/ijkd.7306.

Hyperuricosuria and hypercalciuria, probable etiologies of functional abdominal pain: A case-control study.

Background: Functional abdominal pain (FAP) is a common complaint causing several referrals to pediatricians. On the other hand, the most common presentation of hyperuricosuria and also hypercalciuria is chronic/recurrent abdominal pain. Therefore, a hypothesis has been raised; abdominal pain due to hyperuricosuria and/or hypercalciuria may be misdiagnosed as FAP. The current study has aimed to respond to this theory. Materials and Methods: This is a case-control study conducted on children diagnosed with FAP based on Rome IV criteria and age-matched normal controls. Blood and random urine samples were taken from healthy children and those with FAP. Random urine samples were examined for calcium, uric acid, oxalate, and creatinine concentrations. Random urine calcium to urine creatinine above 0.2 mg/mg was considered hypercalciuria and random urine uric acid above 0.56 mg/dl, GFR as hyperuricosuria. The data were analyzed using logistic models. Results: Hypercalciuric children had a significantly lower chance of FAP (odds ratio [OR] =0.425, 95% confidence interval [CI] =0.204-0.886). Although an inverse association was seen between hyperuricosuria and FAP (OR = 0.693, 95% CI = 0.395-1.214), it was not statistically significant. In stratified analyses by gender for both hyperuricosuria and hypercalciuria, a marginal inverse significant association was seen in male gender (P < 0.1). Conclusion: Our study showed that hypercalciuria is significantly in inverse association with FAP but not hyperuricosuria. Therefore, these disorders, particularly hyperuricosuria may not be considered as the possible causes of FAP. Further studies with larger sample size for providing more reliable evidence are recommended.

Relationship of lipoprotein lipase gene variants and fasting triglyceride levels in a pediatric population: The CASPIAN-III study.

BACKGROUND: Lipoprotein lipase (LPL) is one of the major enzymes responsible for the hydrolysis of triglyceride (TG)-rich lipoprotein. The effects of LPL polymorphisms on serum TG are inconsistent among different populations. OBJECTIVES: This study aims to assess the TG serum concentration and distributions of three LPL single nucleotide polymorphisms (SNPs), namely D9N, HINDIII and S447X, in a nationally representative sample of Iranian adolescents. MATERIAL AND METHODS: We studied the associations between SNP genotypes and TG levels in a nationally representative sample of Iranian adolescents. Genotyping was performed in 750 randomly selected participants. We compared the genotypes according to different TG levels. RESULTS: This study comprised 746 participants, with mean ± SD age of 14.6 ± 2.5 years. The distribution of genotypes of D9N and S447X were not significantly different according to TG levels. Regarding the HINDIII polymorphism, the distribution of GG, GT, and TT genotypes were significantly different in participants with low, borderline-high, and elevated TG (p = 0.02, 0.03, and 0.01, respectively). The mean TG was not significantly different according to the genotype distribution. CONCLUSIONS: In this study, most of the LPL gene variants were not significantly different in adolescents with normal and elevated TG, and the mean TG was not different in participants with various genotypes. As the first evidence from the pediatric population of the region of the Middle East and North Africa (MENA), these results might be used in international comparisons. Our findings might suggest that the high prevalence of hypertriglyceridemia in Iranian adolescents is more likely to be a result of lifestyle rather than genetic factors.

Early effects of burning rice farm residues on respiratory symptoms of villagers in suburbs of Isfahan, Iran.

Villagers residing in areas with rice farms are exposed to smoke from burning of agricultural waste that may affect respiratory health. To assess respiratory effects of this smoke-induced air pollution, a cross-sectional study has been conducted in three randomly selected villages of Isfahan rural areas. A physician-administered health questionnaire was completed for 433 male and 561 female villagers aged 1-80 years, followed by physical examinations and spirometry in symptomatic cases, before and after a rice burning episode in October 2000. Total particulate and respirable particulate maters (PM 10 was doubled during burning episode. Prevalence rates for respiratory symptoms before smoke were: recent asthma attacks (7.7%), using asthma medications (3%), sleep disturbed by dyspnea and cough (7.4%), exercise-induced cough (13.3%), which increased to 9.5, 7.1, 9.3 and 17%, respectively. Mean initial values (as percent of prediction) for; FEV1, FEV1/FVC, PEFR, and FEF25-75 were: 85.9 +/- 22.7, 81.7 +/- 8, 86.2 +/- 26.2 and 60 +/- 26.4, respectively. The mentioned values decreased to to 83.2 +/- 19.5, 76.5 +/- 10.3, 85.5 +/- 21.1 and 54.3 +/- 26.4, respectively. All of the clinical and spirometric changes were statistically significant. Study findings suggest increased respiratory morbidity associated with rice burning episodes among all people living in the area.

Prevalence of self-reported respiratory symptoms in rural areas of Iran in 2000.

OBJECTIVES: The aims of the present study were to measure the population prevalence of symptoms of asthma, chronic bronchitis, obstructive lung disease and non-specific respiratory symptoms in randomly selected rural communities in south-west Isfahan, Iran. METHODOLOGY: Nine hundred and ninety-four subjects from a total of 1127 villagers (88.2% response rate) took part in a medical interview conducted by interns from the Isfahan Medical School. RESULTS: The mean (+/-SD) age of the population surveyed was 25.21 +/- 17.55 years and the smoking rate was 7.2%. The self-reported prevalence rates for current asthma, chronic bronchitis, non-specific exercise-induced cough and night cough were 6.1, 4.4, 13.3 and 11.3%, respectively. CONCLUSION: Asthma, chronic bronchitis and other respiratory disorders in rural Isfahan are more prevalent than expected for a young rural population with low smoking rates. The cause of this should be investigated.