Journal of Renal and Hepatic Disorders
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Manganese-Induced Nephrotoxicity Is Mediated through Oxidative Stress and Mitochondrial Impairment
Get PDFManganese (Mn) is an essential element that is incorporated in various metabolic pathways and enzyme structures. On the other hand, a range of adverse effects has been described in association with Mn overexposure. Mn is a well-known neurotoxic agent in mammals. Renal injury is another adverse effect associated with Mn intoxication. No precise mechanism for Mn nephrotoxicity has been identified so far. The current study was designed to evaluate the potential mechanisms of Mn-induced renal injury. Rats were treated with Mn (20 and 40 mg/mL, respectively, in drinking water) for 30 consecutive days. Markers of oxidative stress, as well as several mitochondrial indices, were assessed in the kidney tissue. Renal injury was evident in Mn-treated animals, as judged by a significant increase in serum BUN and creatinine. Moreover, urinalysis revealed a significant increase in urine glucose, phosphate, and protein in Mn-treated rats. Kidney histopathological alterations, including tubular atrophy, interstitial inflammation, and necrosis, were also detected in Mn-treated animals. Biomarkers of oxidative stress, including an increment in reactive oxygen species (ROS), lipid peroxidation, and oxidized glutathione (GSSG), were detected in Mn-treated groups. On the other hand, kidney glutathione (GSH) stores and total antioxidant capacity were depleted in Mn groups. Mn exposure was associated with significant mitochondrial depolarization, decreased mitochondrial dehydrogenases activity, mitochondrial permeabilization, and depletion of adenosine triphosphate (ATP) content. These data highlight oxidative stress and mitochondrial impairment as potential mechanisms involved in Mn-induced renal injury
Acute Kidney Injury and Acute Liver Failure in Leptospira Infection and Weil’s Syndrome
Get PDFLeptospirosis is considered a zoonosis acquired predominantly from contaminated surfaces and water, more commonly in emerging countries with limited sanitary conditions. Leptospira in the host unleashes an immune response that explains the symptoms and clinical signs; once it reaches the kidney and liver tissue, it can manifest with alterations that lead to acute and chronic diseases in both organs. Weil’s syndrome is the best known clinical manifestation with jaundice and acute kidney injury that could lead to multiple organ failure and death. For its diagnosis, there are simplified scores such as the SPiRO score, the microbiological criteria by microscopy or serological tests; the treatment focuses on antibiotics and, if necessary, provides organic support until the infection is curtailed. The purpose of this review was to address the impact of Leptospira infection on the kidney and liver, the mechanisms of organ damage, the clinical presentation, and diagnosis and management of this disease
Histological Evaluation of Extended Criteria Donors: Donor’s Kidney Biopsy and Graft Outcome after 5 Years of Transplantation
Get PDFPre-transplant kidney biopsy is routinely used to decide whether kidneys from marginal donors should be transplanted as single or double trans-plantation. This is a 5-year extension of the follow-up of a previous study. In that study, graft outcomes were compared retrospectively between a group of 44 recipients of a single kidney graft from an extended criteria donor and a Karpinski histological score of ≤3, and another group of 56 recipients of a single transplant with a Karpinski histological score of 4 or 5. After 5 years of transplantation, there was no difference between the two groups in terms of recipient’s serum creatinine levels (1.8 ± 0.5 vs 1.9 ± 0.6 mg/dL, P = 0.5), creatinine clearance (53 ± 23 vs 49 ± 27.0 mL/min, P = 0.6), or the rates of graft loss (41% vs 49%,P = 0.5). Therefore, the choice between single and double transplant should not be made only on the basis of histological score but should be done together with the evaluation of donor’s clinical parameters, especially the renal function
Study of Urinary Alpha Glutathione-S-Transferase in Children with Idiopathic Nephrotic Syndrome
Get PDFGlomerulopathy associated with recurrent or persistent proteinuria may lead to progressive tubulointerstitial fibrosis. Early detection of tubulointerstitial fibrosis may result in a more favorable outcome of chronic kidney disease (CKD) because nephroprotective treatment may be instituted in due course. One of the early markers of tubulointerstitial fibrosis is glutathione S-transferase (GST). The aim of this study was to determine urinary alpha-GST in children with idiopathic nephrotic syndrome (INS), either in remission or relapse. This case–control study included 40 children with primary nephrotic syndrome (NS), either in remission or relapse. Also, 40 healthy children, age- and sex-matched as controls, were selected from the outpatients and the pediatric nephrology unit of Al-Zahraa Hospital, Al-Azhar University. Urinary alpha-GST was investigated in the study groups on the same lines as that of routine investigations of INS. Children with INS have significantly higher urinary GST either in remission or relapse, it was (5.23 ± 1.90) ng/mL, (5.32 ± 1.52) ng/mL respectively compared with healthy controls, it was (2.59 ± 1.12) ng/mL with (P = 0.001). A positive correlation between urinary alpha-GST and body weight BW, height, body mass index (BMI), white blood cells (WBCs) count, erythrocyte sedimentation rate, serum (cholesterol, triglyceride [TG]) level, blood urea nitrogen (BUN), and duration of the disease. Urinary alpha-GST was increased in children with NS even after remission, and it consequently led to oxidative stress and tubulointerstitial fibrosis. Nephroprotective treatment is recommended even in cases with INS, either in remission or relapse
The Comparison of Outcome in Treating Proximal Ureteric Stones of Size 10 mm to 15 mm Using Extracorporeal Shock Wave Lithotripsy as Compared to Ureterorenoscopic Manipulation Using Holmium Laser
Get PDFUrinary stone disease or nephrolithiasis, the third most common disease of the urinary tract, is a major health issue due to its high prevalence, occurrence, and recurrence. The hallmark of a stone that obstructs the ureter or renal pelvis is excruciating, intermittent pain that radiates from the flank to the groin or to the inner thigh. Stone size influences the rate of spontaneous stone passage. Our aim was to compare the efficacy & the frequency of stone-free patients after intervention at 1 week after extracorporeal shock wave lithotripsy (ESWL) and ureterorenoscopic (URS) manipulation for proximal ureteric stone (10–15 mm size). This randomized control trial was done in the department of Urology, KRL Hospital Islamabad from 18th Nov 2019 to 18th May 2020. After meeting the inclusion criteria, 100 patients were enrolled and were divided into two groups. The first group was treated with ESWL and the other with URS. Then, procedures were done. Follow-up was noted after 1 week in the stone clinic. The average age of the patients was 39.71 ± 10.17 years. Efficacy in the ESWL group was found in 68% cases while in the URS group, efficacy was noticed in 76% cases (P > 0.05). Male patients were three times at a higher risk of recurrence as compared to females. This study concluded that both ESWL and URS are equally effective statistically in terms of the frequency of stone-free patients at 1 week for proximal ureteric stone (10–15 mm size)
The Novel Coronavirus 2019 Epidemic and the Kidneys
Get PDFThe Severe Acute Respiratory Syndrome Coronavirus 2 is a recent disease that originated in China by the end of 2019. The origins of the dis-ease can be traced to bats, but it has been transmitted to humans, and the inter-human transmission is particularly rampant which has led to a pandemic of unseen proportions. The organ principally involved is the lungs, and severe pneumonia with lack of oxygen leads to fatalities. The aim of this review was to study the involvement of the kidneys with regard to COVID-19 infection and how the disease may affect people on hemodialysis or those who have undergone a kidney transplant. Indeed, the virus, in addition to the lungs, may affect other vascularized organs to a common receptor on lung epithelium and the endothelium of any organ. The kidney, which has a large endothelium surface, is affected, and COVID-19 may lead to acute renal failure. On the other hand, the virus may easily spread among people who are on hemodialysis three times a week. People on hemodialysis may have low immunity, and the virus may have dangerous effects on such people. Finally, renal transplant patients may be easily affected, and the virus may have severe consequences, even death. We will summarize the principal prophylactic measures to be adopted and the therapeutic measures available. Clearly due to the recent occurrence of the pandemic the majority these measures lack a basis in evidence-based medicine and only highlight the efforts to limit COVID-19 induced damage
Therapeutic Apheresis in Glomerular Diseases after Kidney Transplantation
Get PDFTherapeutic apheresis is an extracorporeal treatment that selectively separates abnormal cells or substances from the blood that are linked with or cause certain disease states. It is widely used in transplantation medicine as an adjunctive therapeutic option. In kidney transplantation (KT), recurrent and de novo glomerular diseases represent the third most common cause of graft failure beyond the first year after transplantation, as current therapeutic options are limited. Evidence to support the use of therapeutic apheresis in these conditions is scarce, as it is only supported by observational studies. The purpose of this review was to examine and clarify the potential role of therapeutic apheresis and describe current evidence in the treatment of recurrent and de novo glomerular diseases after KT
Conversion from Extended-Dose-Release Tacrolimus to Melt-Dose Tacrolimus in High Metabolizer Patients: Is the New Formulation of LPCT the Best Option for High Metabolizer Kidney Transplanted Patients?
Get PDFTacrolimus (FK506) is the most widely used anti-rejection drug in kidney transplantation, especially its extended release Tacrolimus formulation (ER-Tac, Advagraf), which is used when target blood levels can be difficult to reach in high metabolizer patients. In this retrospective monocentric study, we analyzed the effect of a switch from ER-Tac to LifeCycle Pharma Tacrolimus (LPCT, Envarsus) on the dose/level ratio of FK506 in high metabolizer patients that cannot achieve target blood levels in the first 6 months after transplantation. We observed a statistically significant improvement in the level to dose ratio after the switch. Renal function remained stable. We also observed a reduction in the development of tremors. Our data suggest that LPCT can be used in a safer way in high metabolizer kidney transplant recipients
Yersinia enterocolitica Infection in Patients Undergoing Intermittent Hemodialysis
Get PDFEnd-stage renal disease is the last stage of chronic kidney disease and affects more than 2 million patients worldwide. The infection-related hospitalization is an important cause of excess morbidity and mortality in this group of patients. Yersinia enterocolitica (YE) is one of the bacteria that hemodialysis (HD) patients can occasionally be infected with. The most common symptoms are fever and mild diarrhea, which is self-limited. However, in HD patients, especially in iron-overloaded cases, severe watery or bloody diarrhea can occur. The consumption of undercooked food by patients should sensitize the physician to the possibility of YE infection. Clinically, YE is difficult to diagnose due to nonspecific symptoms and the relatively low prevalence of yersiniosis, compared to other causative pathogens in dialysis patients. There is little information about yersiniosis in HD patients. For this reason, this review aims to summarize the current knowledge on YE infection in HD patients, with the main objective of expounding the problems in identifying, diagnosing, and treating yersiniosis in HD patients
The Effect of Clinical and Demographic Factors on Quality of Life in End-Stage Renal Disease. A Multicenter Cross-Sectional Study
Get PDFThe aim of this study was to assess the quality of life (QoL) in end-stage renal disease (ESRD) patients undergoing hemodialysis and to examine the clinical and demographic attributes associated with it. This is a multicenter, cross-sectional study, conducted in 2018, in which 367 patients with ESRD undergoing hemodialysis were recruited. Data were collected through a two-part anonymous, self-completed questionnaire. The first part contained questions regarding demographic, social, and clinical information, and the Greek version of Missoula–Vitas Quality of Life Index-15 (MVQoL-15) scale was used to assess QoL. Descriptive and inferential statistical methods were applied. All reported p-values were two-tailed, and the statistical significance level was set at 0.05. Of the study participants, 62.1% were male, with a mean age of 61.80 ±15.11. Of the participants, 67.3% were living in urban areas and 59.1% were married. The majority of the Hemodialysis (HD) patients evaluated possessively all the domains of MVQoL except the wellbeing Domain. QoL was found to be influenced, among others, by age (0.001), occupation (0.002), education (0.003), and additional health problems (<0.001). The role of patient characteristics in QoL is an area of interest, and early and proper intervention is important to enhance QoL