The Iranian Journal of Kidney Diseases (IJKD), a peer-reviewed journal in English, is the official publication of the Iranian Society of Nephrology. The aim of the IJKD is the worldwide reflection of the knowledge produced by the scientists and clinicians in nephrology. It has been published quarterly since 2007 and every 2 months since January 2011. The IJKD provides a new platform for the advancement of the field. The journal’s objective is to serve as a focal point for debates and exchange of knowledge and experience among researchers in a global context. Original papers, case reports, and invited reviews on all aspects of kidney diseases, hypertension, dialysis, and transplantation will be covered by the IJKD. Research on the basic science, clinical practice, and socio-economics of renal health are all welcomed by the journal editors. Indexing/Abstracting. SCI Expanded, MEDLINE, EMBASE, Scopus, Cinahl, CAB International, Index Copernicus, Index Medicus for the WHO Eastern Mediterranean Region (IMEMR), Scientific Information Database (SID), and Google Scholar
Predictors of Kidney and Patient Survival in Monoclonal Gammopathy–Associated Kidney Disease: A Single-Center Cohort from Colombia
Introduction. Monoclonal gammopathies can induce various kidney disorders through the deposition of monoclonal immunoglobulin. Precise recognition and classification are essential for predicting outcomes and customizing treatment. However, data on prognostic factors in Hispanic and Latin American populations remain scarce. This study aimed to determine the predictors of kidney and patient survival in adults with biopsy-proven monoclonal gammopathy-associated kidney disease. Methods. We conducted a retrospective cohort involving 98 individuals with biopsy-confirmed disease evaluated between 2011 and 2022. Kidney and patient survival were estimated using Kaplan-Meier analysis, and differences across histopathologic subtypes were assessed with the log-rank test. Predictors of end-stage kidney disease (ESKD) and mortality were identified using univariate and multivariable Cox regression after verification of the proportional hazards’ assumption. Results. Approximately one third of patients required kidney replacement therapy (KRT) at presentation. The need for KRT (hazard ratio [HR] 4.86, 95% confidence interval [CI] 2.01-11.79) and an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m² (HR 4.02, 95% CI 1.38-11.71) independently predicted progression to ESKD. Amyloidosis (HR 2.38, 95% CI 1.22-4.86) and age > 60 years (HR 1.96, 95% CI 1.06-3.61) were associated with higher mortality. The median follow-up was 41 months (interquartile range 24-68); 31% progressed to ESKD and 46% died. Conclusions. Severe kidney dysfunction and the need for replacement therapy at diagnosis are strong predictors of poor renal outcomes. Amyloidosis and older age significantly affect overall survival. Early recognition of high-risk patients and access to effective, clone-directed therapy are essential to improve prognosis in resource-limited settings.
Paraproteinemias, Monoclonal gammopathy of undetermined significance, Kidney biopsy, AL amyloidosis, Monoclonal gammopathy of renal significance, Multiple myeloma.
Prognostic factors for ESKD in monoclonal gammapathies.
Nephrology, Pathology, Clinical Medicine, Hematology
Copyright (c) 2026 Iranian Journal of Kidney Diseases
Years of Potential Life Lost (YPLL), the Key Metric in Strategic Planning for Chronic Kidney Disease Care
Efficacy and Safety of Oral Antidiabetic Drugs in People with Diabetes and Chronic Kidney Disease: A Systematic Review
This study is a systematic review assessing the efficacy and safety of oral antidiabetic drugs in managing type 2 diabetes mellitus in people with chronic kidney disease (CKD), focusing on their dosing and effects on renal function and glycemic control. A systematic search of online databases was conducted for published from January 2023 to September 2024. Studies that focused on oral antidiabetic drugs for individuals with diabetes and CKD, and reported outcomes such as glycemic control, renal function, and adverse events were included. A risk-of-bias assessment was performed to evaluate study quality. A total of 21 studies that met the criteria were included. The evidences indicate that SGLT2 (Sodium-Glucose Cotransporter-2) inhibitors and GLP-1 (Glucagon-like peptide-1) receptor agonists provide renal protective benefits. SGLT2 inhibitors are more effective especially in early-stages of CKD. DPP-4 (Dipeptidyl peptidase 4) inhibitors are safe across various CKD stages and require minimal dose adjustments. Metformin remains a popular drug for glycemic control but should be monitored and even discontinued in advanced stages of CKD because of the risk of lactic acidosis. Sulfonylureas were related to hypoglycemia risk. Oral antidiabetic drugs, especially SGLT2 inhibitors and GLP-1 receptor agonists, are suggested in managing blood glucose in CKD patients owing to their renal and cardiovascular benefits. Individualized therapy is an important factor as drug safety and efficacy are influenced by CKD stage, comorbid conditions, and hypoglycemia risk. Individualized therapy helps maximize renal and cardiovascular protection while minimizing adverse outcomes. Regular monitoring of HbA1c (hemoglobin A1c), GFR (glomerular filtration rate), and albuminuria is recommended.
Copyright (c) 2025 Iranian Journal of Kidney Diseases
Bibliometric Analysis of Uremia Research: 2021–2025
Introduction. This study aimed to perform a bibliometric analysis of academic research on uremia, identifying research hotspots, development trends, and international collaboration networks in this field. Methods. Relevant publications related to uremia were retrieved from Web of Science database. Bibliometric analysis was conducted using R software. Co-occurrence analysis of keywords, co-citation network analysis, and author/country collaboration analysis were performed to explore research focuses and academic influence. Results. From 2021 to 2022, research on uremia mainly concentrated on traditional areas such as chronic kidney disease, hemodialysis, and patient management. Since 2023, the focus has gradually shifted toward emerging topics including plasma biomarkers, inflammation mechanisms, and precision patient care. Co-citation network analysis revealed that studies related to chronic kidney disease and hemodialysis had the strongest academic influence, while research on inflammation and uremia also occupied central positions in the network. International collaboration was most active in China, the United States, and Europe, reflecting a trend toward cross-border and interdisciplinary research. Meanwhile, keywords such as gut microbiota, metabolomics, and precision medicine are increasingly frequent, highlighting new research frontiers. Conclusion. This study demonstrates that uremia research is shifting from traditional areas such as chronic kidney disease and hemodialysis toward emerging themes including inflammation, biomarkers, and patient management. These findings provide objective evidence of research hotspots and trends in uremia and underscore the importance of enhancing international and interdisciplinary collaboration.
Uremia; Bibliometrics; Chronic Kidney Disease; Inflammation; Dialysis
Non-Diabetic Kidney Disease Confirmed by Biopsy in Patients with Diabetes: A Single-Center Registry Report
Introduction. Diabetic kidney disease (DKD) is a major complication of diabetes mellitus (DM), often leading to kidney failure. This study was designed to assess the prevalence and clinicopathological correlations of biopsy-confirmed non-diabetic kidney disease (NDKD) in patients with diabetes. Method. A retrospective analysis was conducted by including 547 diabetic patients who underwent kidney biopsies. Data on demographics, laboratory results (including serum creatinine and urine protein levels), clinical symptoms, medical history, and histopathological diagnoses were collected. Result. Among the patients, 261 (47.7%) were diagnosed with DKD, while 286 (52.3%) had NDKD. The most prevalent histopathologicalfinding in NDKD was membranous glomerulonephritis (13.9%), followed by focal and segmental glomerulosclerosis (9.7%) and IgA nephropathy (5.7%). Key predictors for DKD included longer duration of diabetes mellitus (odds ratio [OR]: 1.12), elevated HbA1c levels (OR: 1.26), and the presence of retinopathy at the time of biopsy (OR: 7.97), all with P < .05. No significant differences were observed in the frequency of hematuria between the DKD and NDKD groups. Conclusion. Membranous glomerulonephritis was the most common diagnosis among NDKD patients. The findings suggest a strong correlation between the duration of diabetes mellitus, the presence of retinopathy, and HbA1c levels with DKD development, indicating a need for revised criteria for kidney biopsy decisions in diabetic individuals to enhance diagnostic accuracy and treatment strategies.
The Association Between Serum Sodium Variation During Pediatric Intensive Care Unit Admission and the Risk of Clinical Outcomes in Critically Ill Children: A Retrospective Cohort Study
Introduction. Dysnatremia at Pediatric Intensive Care Unit (PICU) has been associated with adverse outcomes; however, the impact of sodium variation during PICU stay remains underexplored. We aimed to assess the association between dysnatremia and sodium fluctuations during PICU admission and the probability of prolonged PICU stay (≥7days) and mortality. Methods. This retrospective cohort study included 966 critically ill children (2019–2022) with at least two serum sodium measurements during PICU admission. Patients were classified as normonatremic, hyponatremic, hypernatremic, or mixed dysnatremic based on all sodium values. Sodium fluctuation was defined as the difference between the highest and lowest sodium levels during admission and categorized into quartiles. Associations of dysnatremia categories and sodium fluctuation with prolonged PICU stay and PICU mortality were evaluated using multivariable logistic regression. Results. During the PICU admission, 542 patients developed dysnatremia. The PICU-acquired dysnatremia was independently associated with higher odds of prolonged PICU stay after adjusting for major confounders. The PICU-acquired hypernatremia (OR:5.23;95%CI:1.72-15.92) and mixed dysnatremia (OR:2.89;95%CI:1.14-7.29) had significantly higher odds for PICU mortality. Even mild sodium fluctuations (4-8mmoL/L) during PICU admission were significantly associated with higher odds of prolonged PICU stay. The highest (≥15mmol/L) fluctuations in serum sodium levels during PICU admission were also significantly associated with higher odds of PICU mortality (OR:2.74;95%CI:1.11-6.79). Conclusion. Our findings underscore the importance of careful monitoring of serum sodium levels during PICU admission to improve clinical outcomes. These results should be interpreted in light of the retrospective design and the unavailability of standardized illness-severity scores (e.g., PRISM or PIM) in the dataset.
serum sodium variation during Pediatric Intensive Care Unit admission and the risk of clinical outcomes in critically ill children
The Trend of Mortality Rate and Years of Life Lost Due to Kidney Failure in Fars Province, Iran, During the Years 2004-2019
Introduction. Chronic kidney disease is a general term for heterogeneous disorders that affect the structure and function of the kidney. This study was conducted to determine the mortality rate and years of life lost due to kidney failure in southern Iran. Method. In this retrospective, population-based descriptive trend study, all deaths due to kidney failure in Fars province were extracted from the electronic population-based death registration system (EDRS). The crude mortality rate, age-standardized mortality rate, years of life lost (YLL) and YLL rate data were calculated. The Joinpoint Regression method was used to examine the trend. Results. During the 16-year study period, 2853 deaths due to kidney failure occurred in Fars province. Of this number, 57.2% (1633 cases) were men. The crude mortality rate had a stable trend in men and an increasing trend in women. However, the age-standardized mortality rate had a stable trend in both sexes. The total years of life lost due to kidney failure were 19366 in men and 15769 in women. According to the Joinpoint regression analysis, the trend of YLL rate due to premature mortality was stable and the annual percent change (APC) were -2.6% (95% CI -5.6 to 0.4, P = .088) and 1.8% (95% CI -1.9 to 5.6, P = .318) for males and females respectively. Conclusions. The trend of crude mortality rate had a stable trend in men and an increasing trend in women. Also, the trend of YLL was stable for both sexes. The increasing trend in mortality among women may be due to increases in life expectancy and the increasing prevalence of non-communicable diseases such as hypertension and diabetes mellitus.
Inflammatory Mediators in Kidney Disease: A Focus on IL-6in SLE-Associated CKD
Introduction. Systemic lupus erythematosus (SLE) is an autoimmune condition that can lead to severe renal impairment, including chronic kidney disease (CKD) or end-stage kidney disease (ESKD). This study aimed to evaluate the serum levels of key pro-inflammatory cytokines which are well-known to mediate tissue injury and fibrosis in the context of kidney diseases—interleukin-1 beta (IL-1β), IL-6, tumor necrosis factor-alpha (TNF-α), and IL-12—in CKD and ESKD patients with and without SLE, as well as in healthy controls, to explore their role in disease progression. Methods. This cross-sectional study was conducted over a 15-month period in three governmental medical centers of Golestan Province, Iran (Sayyad Shirazi Hospital, 5th Azar hospital, and Al-Jalil hospital). A total of 118 individuals (age 18-65 years) were enrolled and divided into three groups:38 CKD or ESKD patients with SLE, 40 CKD or ESKD patients without SLE, and 40 healthy controls. For subgroup analyses, CKD (stages3-4) and ESKD (stage 5) patients were considered separately. Those patients meeting the American College of Rheumatology criteria for SLE, while excluding those with infections, malignancies, or other autoimmune disorders were selected. Blood samples were collected, and serum cytokine levels were measured using enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed using the Kruskal-Wallis and Mann-Whitney U tests, with P ≤ .05 considered significant. Results. CKD patients with SLE showed significantly higher serum levels of IL-1β, TNF-α, and IL-12 compared to CKD patients without SLE and healthy controls (P < .05). IL-6 levels were notably higher in CKD patients compared to ESKD patients, irrespective of SLE status (P < .05). ESKD patients exhibited increased IL-1β, TNF-α, and IL-12 levels, while IL-6 levels were lower than those in CKD patients. Conclusion. IL-6 appears to play a crucial role in the pathogenesis of kidney disease, particularly in patients with SLE, and may serve as a therapeutic target. The differential regulation of cytokines in CKD and ESKD suggests that inflammatory pathways vary based on disease stage and the presence of SLE.
The Sensitivity of Bioimpedance to Assess Leg Fluid Volume Changes in Children on Hemodialysis: Experimental and Model-Based Investigation
Introduction. Fluid management plays an essential role in pediatric hemodialysis; however, traditional assessment techniques often lack the precision required for this patient population. Bioimpedance analysis (BIA) offers a non-invasive alternative, but electrode placement significantly impacts measurement sensitivity. This study compared the efficacy of two calf-based electrode configurations — dorsal (ankle) versus plantar (sole) — in detecting fluid volume changes via bioimpedance in pediatric patients, particularly in terms of their sensitivity. Additionally, we evaluated a novel ring electrode arrangement for optimizing sensitivity distribution in lower limb tissues. Methods. This controlled before-and-after study was conducted at the dialysis unit of Ali Asghar Children’s hospital in Tehran, Iran. It evaluated thirteen children (aged 3-15 years) undergoing hemodialysis using bioimpedance analysis. The primary outcome measure was the change in impedance values before and after a single dialysis session. Measurements were performed with electrodes placed in two configurations: between the plantar surface of the foot to below the knee (down), and between the ankle dorsal surface to below the knee (up). Current distribution patterns were modeled using COMSOL simulations. Results. Mean ultrafiltration volume was 1123 ± 384 mL per session. Impedance changes were observed in both dorsal and plantar electrode configurations, with no significant differences or superiority in measuring these changes. Sensitivity analysis revealed variations of 35% with dorsal placement, 24% with plantar placement, and 20% with ring electrode configuration, demonstrating superior uniformity of the ring design across tissue regions. Conclusion. Optimal electrode placement varies among patients with no universal advantage for either position. Bioimpedance sensitivity depends on location of fluid accumulation, and enhanced sensitivity is required for monitoring changes below two liters. The ring electrodes provided the most uniform sensitivity distribution. These findings support use of personalized bioimpedance monitoring approaches to improve fluid management precision in pediatric hemodialysis.
Diagnostic Techniques and Procedures; Blood Volume Determination; Electrodes; Dialysis, Bioelectrical impedance analysis; Pediatrics
Genetically Confirmed Hyperoxaluria in Iranian Children- A Multicenter Survey
Introduction. Primary hyperoxaluria (PH) is a rare autosomal recessive disorder characterized by a heterogeneous presentation that leads to kidney failure and involvement of other organs. The aim of this study was to determine the number of cases with suspected PH in Iran that have had a genetically verified diagnosis. Methods. A survey distributed among members of Iranian society of pediatric nephrology (IranSPN) to collect overall data on hyperoxaluria (HOX) in their centers, as well as those who performed whole exome sequencing (WES) or sanger sequencing genetic study. Data is presented as frequency and number blocks. Results. Nineteen out of 130 members filled out the questionnaires. About two-thirds of the responders were suspected to have HOX in the presence of recurrent multiple kidney stones. PH was genetically confirmed in 80 children above 10 years. Alanine-Glyoxylate Aminotransferase (AGXT) was the most frequent reported genetic abnormailtiy. The majority of their patients required kidney replacement therapy. Combined or sequential liver- kidney transplantation was less frequent. Conservative treatment was the only therapy applied to all children prior to end-stage kidney disease. Conclusion. This simple survey revealed that definitive diagnosis of PH occurs at older age accompanied with higher rate of kidney transplantation.
Combined or sequential liver and kidney transplantation
Predictors of Survival and Clinical Outcomes in Hemodialysis Patients: A 9-Year Multicenter Cohort Study
Introduction. Cardiovascular and non-cardiovascular mortality rates among hemodialysis patients continue to be high despite advances in dialysis therapy. Materials and Methods. This prospective cohort study enrolled 185 adult patients with end-stage kidney disease (ESKD) on maintenance hemodialysis (HD) from three hemodialysis facilities (Shariati hospital, Shohadaye Hafte-Tir hospital and Sevome-Sha’ban hospital ) in September 2012. Causes of death and HD exit were tracked over a follow-up period of 103 months (8.5 years). The Cox proportional hazards model was employed to predict mortality after adjusting for case-mix and laboratory data variables. Results. The mean age of the patients was 57 ± 15.2 years, with a mean dialysis vintage of 39 ± 45 months. The cohort comprised 52.5% males and 48% diabetic patients. In the univariate analysis, mortality rate was higher among women (81% vs. 63%), diabetics (89% vs. 55%), and those with higher body mass index, older age, and lower serum creatinine, albumin, and intact PTH levels. A total of 132 patients (71%) died, with a mortality rate of 19 per 100 patient-years. The leading causes of death were cardiovascular diseases (47%) and infections (32.5%). Kidney transplantation was performed in 25 patients (14%), including 7 women and 18 men. The median survival was 4.1 years (95% CI: 3.3-5.0). The survival rates at one, two, three, five, and nine years were 83%, 64%, 56%, 39%, and 19%, respectively. Conclusion. Older age, poor nutritional biomarkers, diabetes mellitus, and catheter vascular access are the primary factors contributing to poor long-term prognosis in hemodialysis patients.
Post-Transplantation Hairy Cell Leukemia with Hemophagocytic Lymphohistiocytosis in an Adult Kidney Transplant Recipient: A Case of Rare Occurrence
Post-transplant lymphoproliferative disorder (PTLD) is a rare and severe complication that occurs after kidney transplantation. Most cases of PTLD are associated with reactivation of the Epstein-Barr virus (EBV), which often happens during the early phases following transplantation. Hemophagocytic lymphohistiocytosis (HLH) is an inflammatory syndrome characterized by a cytokine storm originating from activation of the reticuloendothelial system, leading to multi-organ failure (MOF). Herein, we present a case of late-onset EBV-positive hairy cell leukemia in a kidney transplant recipient who concurrently developed HLH. Diagnosing and managing HLH can be particularly challenging, as it can mimic sepsis. This is especially true for transplant recipients, where diagnosing and treating such conditions are difficult. Immunosuppressive therapy, malignancies like lymphoma, and EBV infection are recognized risk factors for developing HLH. However, very few cases have reported the simultaneous occurrence of HLH and PTLD.
Hemophagocytic Lymphohistiocytosis (HLH)
Post-Transplant Lymphoproliferative Disorder (PTLD)
A Rare Cause of Retroperitoneal Fibrosis in Adults: H Syndrome Presenting After 35 Years- A Case Report
Introduction. Retroperitoneal fibrosis (RPF) is a rare fibro- inflammatory disorder that may cause urinary tract obstruction and renal failure. Although most RPF cases are IgG4-related, rare genetic conditions can also contribute to the disease. H syndrome, an autosomal recessive disorder caused by biallelic SLC29A3 mutations, usually presents in childhood with cutaneous, endocrine, and systemic manifestations; adult onset is exceptionally rare. Case presentation. A 36-year-old woman was admitted to hospital with the complaint of nausea, vomiting, and oliguria. Laboratory tests showed urea 116 mg/dL, creatinine 5,8 mg/dL,. Non-contrast computed tomography imaging revealed bilateral hydronephrosis and a 2,5 cm retroperitoneal fibrotic mass encasing the abdominal aorta and iliac arteries. Extensive evaluation—including positron emission tomography, lymph-node histology, and autoimmune/ IgG4 serology—found no evidence of malignancy, infection, or IgG4- related disease. Family history disclosed parental consanguinity and a brother with H syndrome. Next-generation sequencingidentified a homozygous SLC29A3 (NM_018344.5):c.1339G > A (p.Glu447Lys) mutation, confirming H syndrome. Bilateral ureteral stenting and corticosteroid therapy led to full renal recovery (creatinine 0.7 mg/dL). Conclusion. This case expands the clinical spectrum of H syndrome by documenting late-onset RPF without typical dermatologic or auditory signs. Recognition of familial risk and timely genetic testing were decisive for diagnosis. Early decompression and immunosuppression preserved renal function. Reporting suchatypical presentations increases awareness of H syndrome as a rare genetic cause of RPF and supports comprehensive genetic evaluation in adults with unexplained retroperitoneal fibrosis.
Optimizing Pediatric Blood Pressure Readings: The Role of Timing and Medical Personnel Presence: A cross-sectional study
Introduction. Hypertension is a major global health concern, playing a significant role in the development of cardiovascular diseases and other non-communicable conditions. Accurate blood pressure (BP) measurement is a key to its diagnosis. While guidelines recommend three BP readings with 1–2-minute intervals for adults, there is no clear consensus for children. Additionally, various factors, such as the presence of medical personnel, could impact BP readings. This study aimed to evaluate the impact of measurement timing and the presence of medical personnel on pediatric blood pressure readings. Methods. In this analytical cross-sectional study, 50 children aged 5-13 years were enrolled. Blood pressure was measured using an automatic device with appropriately sized cuffs. BP was recorded at five intervals: baseline, 30, 60, 90, and 120 seconds. Measurements were taken both in the presence of medical personnel (attended) and without their presence (unattended). Data were analyzed using descriptive statistics and repeated measures ANOVA with IBM SPSS version 21. Results. A significant decrease in systolic BP (SBP) was observed over time (P = .000), with the initial SBP of 105.29 mmHg declining to 98.33 mmHg at 120 seconds. However, there were no significant changes in diastolic BP (DBP) or pulse pressure (PP) (P = .400 and P = .502, respectively). When comparing attended versus unattended measurements, both SBP and DBP were significantly higher whenmedical personnel were present (P = .009 for SBP, P = .010 for DBP). Conclusions. The findings suggest that shorter intervals, such as 30 seconds, may be adequate for reliable BP measurement in children. However, the presence of medical personnel increases BP readings, likely due to anxiety. These results highlight the need to reduce stress during pediatric BP assessments to ensure accurate hypertension diagnosis and management.
Examining the Association between Oxidative Stress Markers and the Severity of Symptoms in Individuals with COVID-19 and Healthy Individuals
Introduction. The association between inflammation and oxidative stress in COVID-19 patients is well documented. The primary objective of the present study was to evaluate the levels of oxidative stress markers in COVID-19 patients compared to the healthy individuals. Methods. In this case-control study, a comprehensive evaluation was conducted on 45 individuals, comprising 30 patients diagnosed with COVID-19 and 15 in a healthy control. COVID-19 patients were divided into two groups: mild and severe, based on clinical severity. In addition to standard laboratory tests like ESR, serum levels of oxidative stress markers were measured, including total protein, total antioxidant capacity, total oxidant status, carbonylated protein content, glutathione reductase enzyme, and catalase activity.Results. ESR levels were significantly elevated in the severe group compared to the mild group. However, no significant differences were observed in the levels of oxidative stress markers between mild and severe COVID-19 patients. Compared to healthy controls, COVID-19 patients exhibited a significant decrease in total protein levels (P < .0001), and significant increases were observed in serum total antioxidant capacity (TAC) (P < .0001) and total oxidant status(TOS) (P = .002). Conclusion. Oxidative stress markers exhibit a substantial rise in patients with COVID-19, suggesting a potential role in the progression of the disease. Implementing strategies to prevent oxidative stress may offer clinical advantageous in managing COVID-19 patients.
Calf Bioimpedance Analysis: A Novel Approach for Evaluating Hydration Status in Pediatric Dialysis Patients Under High Dialysate Sodium
Introduction. Assessment of hydration status in pediatric hemodialysis is complicated by dynamic fluid shifts and sodium variability. Conventional methods such as clinical evaluation and whole-body bioimpedance analysis (BIA) lack precision for individual-level monitoring. This study introduces a calf impedance ratio (ΔZ₁₅ₖₕ / ΔZ₁₅₀ₖₕ) to classify fluid responses and evaluate the impact of high dialysate sodium (143 mEq/L) on fluid dynamics and blood pressure. Methods. A cross-sectional study was conducted involving 14 children aged 5–12 years undergoing maintenance hemodialysis. Impedance was measured pre- and post-dialysis at two frequencies using a custom-built device. The raw impedance changes were analyzed without conversion to fluid volumes, allowing for classification into three physiological response groups based on the impedance ratio.Results. Three distinct physiological profiles emerged. Group1 (ΔZΔZ150kh15kh > 1) showed effective extracellular fluid removal with stable hemodynamics. Group 2 (ratio between 0 and 1) reflected minimal Extracellular Water (ECW) ECW changes, potentially due to sodium-driven redistribution, with additional influence from sodium-enhanced tissue conductivity. Group 3 (ΔZ₁₅ₖₕ < 0) exhibited paradoxical impedance decreases despite fluid removal,along with sodium increase and blood pressure elevation. ΔZ₁₅ₖₕpositively correlated with ΔBP-sys (r = 0.650, P = .012). Conclusion. The impedance ratio (ΔZΔZ150kh15kh ) provides a sensitive index for classifying fluid responses and identifying sodium-related effects in pediatric hemodialysis. It may support individualized dialysis prescriptions by guiding adjustments in ultrafiltration and dialysate sodium to improve hemodynamic stability and fluid balance.
Incidence of Hospital-Acquired Hyponatremia and its Risk Factors in Hospitalized Children: A Longitudinal Study
Introduction. Hyponatremia in hospitalized children is associated with several clinical complications. This study aimed to evaluate the incidence and risk factors of hospital-acquired hyponatremia in pediatric patients. Method. A longitudinal study was conducted between 2016 and 2020 on hospitalized children who were admitted in Dr Sheikh Hospital, Mashhad University of Medical Sciences, Iran with normal serum sodium levels. Patients were followed for hyponatremia and its risk factors during hospitalization. Demographic data, clinical symptoms, underlying disease, type of serum, ward of hospitalization, and final diagnosis were recorded. Patients with incomplete blood samples or abnormal serum level of sodium at the time of admission were excluded. Result. A total of 456 children, including 267 males (58.6%) with a mean age of 69.40 ± 42.42 months were studied. The incidence of hyponatremia was 22.1%. The female sex (3.83 (95% confidence interval: 1.08, 13.59)) was the independent risk factors of hyponatremia. Children less than one year of age (2.68 (95% confidence interval: 0.97, 7.42) P = .057), were also borderline significant for the risk of hyponatremia. Conclusion. The incidence of hospital-acquired hyponatremia was 22.1%. The female sex was the independent risk factor of hyponatremia. Children less than one year of age may also be at risk for hyponatremia. Further studies are needed to confirm these findings.
Efficacy of Sacubitril/Valsartan in Treating Hemodialysis Patients with Reduced Ejection Fraction Heart Failure: A Retrospective Study
Introduction. Heart failure with reduced ejection fraction (HFrEF) is a prevalent and challenging complication among patients undergoing hemodialysis. Sacubitril/Valsartan (Sac-Val), an angiotensin receptor-neprilysin inhibitor, has shown promise in improving cardiac outcomes in HFrEF patients. This study aims to evaluate the efficacy and safety of Sac-Val in treating HFrEF in patients undergoing hemodialysis. Methods. This retrospective analysis was conducted on 30 patients with HFrEF undergoing regular hemodialysis at Beijing Shijingshan Hospital between January 2019 and January 2023. The patients were divided into two groups: the Sac-Val group (14 patients) and the control group (16 patients). The Sac-Val group received an initial dose of 50 mg, titrated over four weeks to a maximum tolerated dose of 100 mg, while the control group received conventional heart failure treatment without Sac-Val. Both groups continued regular hemodialysis three times weekly. Statistical analysis included independent t-tests or Mann–Whitney U tests for continuous variables, and chi-square or Fisher’s exact tests for categorical variables. Heart failure improvements, blood pressure, NT-proBNP levels, biochemical markers, and echocardiographic changes were assessed after one year. Results. The Sac-Val group showed significant improvements in systolic blood pressure (P = .027), NT-proBNP levels (P < .05), left ventricular ejection fraction (LVEF) (P < .04) compared to the control group. The Sac-Val group also had a higher total effective rate (85.71%) in alleviating heart failure symptoms compared to the control group (69%, P = .023). Conclusion. Sac-Val is a safe and effective treatment for HFrEF patients undergoing hemodialysis, potentially improving their quality of life, heart function and clinical outcomes.
Heart failure with reduced ejection fraction
Angiotensin receptor-neprilysin inhibitor
Heart failure with reduced ejection fraction (HFrEF)
Erratum:The Effect of 10 Weeks of Aerobic-resistance Exercise Training on Liver Enzymes (ALT, AST, and ALP) and Kidney Function (Creatinine, Urea, and GFR) of Kidney Transplant Patients
The Efficacy of Mumijo Extract in Protecting Against Amoxicillin/Clavulanate-Induced Apoptotic Damage in Renal Tissues of Rats
Abstract: Background: Amoxicillin/Clavulanate (A/C) is a widely used antibiotic that can induce oxidative stress and renal apoptosis through reactive oxygen species (ROS). Mumijo extract (PS), known for its antioxidant and anti-inflammatory properties, has shown promise in mitigating such damage. This study aims to evaluate the efficacy of PS in protecting against A/C-induced renal tissue damage in rats. Materials and Methods: The study included 28 Wistar albino rats, divided into four groups: Sham (saline), A/C (10 mg/kg/day), PS (100 mg/kg/day), and A/C+PS. A/C and PS were administered orally for 21 days. Renal function markers (urea, creatinine), oxidative stress parameters (TAS, TOS, MDA), and histopathological findings were analyzed. Bax and Bcl-2 protein expressions were assessed to evaluate apoptosis. Results: A/C administration significantly increased renal urea, creatinine, TOS, and MDA levels while reducing TAS. Histopathological analysis revealed tubular dilatation, degeneration, and inflammation in the A/C group. PS supplementation in the A/C+PS group significantly reduced oxidative stress markers and improved TAS levels, histopathological scores, and apoptosis indicators (increased Bcl-2 and reduced Bax expressions). PS alone demonstrated no adverse effects on renal parameters. Conclusion: Mumijo extract effectively mitigates A/C-induced oxidative stress and renal apoptosis, preserving tissue integrity and function. These findings suggest PS as a potential therapeutic agent for managing drug-induced nephrotoxicity.
Amoxicillin/Clavulanate, Mumijo extract, oxidative stress, renal apoptosis, antioxidant therapy, Bax/Bcl-2 proteins
Protective Effects of Mumijo on Amoxicillin/Clavulanate Toxicity in Kidney Tissues
The Scent of the Muliyan River (Booye Jooye Muliyan): Report of an Educational Trip
In October 2024, an Iranian educational nephrology team visited Tajikistan to participate in a continuous medical education (CME) course. This report represents the results of their trip from their perspective.
The Effect of Tribulus Terrestris on Acute Kidney Injury: A Case Study
Herbal medications, such as Tribulus terrestris, are widely used, especially by healthy individuals. Despite being easily accessible and perceived as safe, multiple reports have highlighted the potential adverse effects of these medications, although some acknowledge their benefits. In this case report, we present a 43-year-old male patient who has a significant history of self-administered herbal medicine usage. Our aim is to increase awareness about the potential toxicities linked to the use of over-the-counter herbal medicines. Initially, the patient’s elevated creatinine level prompted further investigations, which led to the need for dialysis. Following management, he finally survived and recovered; currently, approximately three months later, the patient remains asymptomatic. This case serves as a cautionary example regarding the potential risks of using herbal medications without proper medical guidance.
Increased Proportion of Circulating T Follicular Helper Cells and Serum Levels of IL-21 in Antibody-Mediated Rejection of Renal Allograft
Introduction. Antibody-mediated rejection (AMR) is one of the major obstacles to successful kidney transplantation. The T helper cell subset that plays a key role in the activation of B-lymphocytes and antibody production is T follicular helper (Tfh) cell. Therefore, we aimed to compare the percentage of Tfh cells and the serum level of interleukin 21 (IL-21), mainly secreted by this subset, in patients with AMR and stable recipients. Methods. Peripheral blood samples were taken from 30 patients diagnosed with AMR and 30 stable kidney transplant recipients as well as 10 age- and sex-matched healthy individuals. The percentage of circulating Tfh cells (TCD4+CXCR5+PD1+) and the level of IL-21 were studied by flow cytometry and ELISA techniques, respectively. Results. The proportion of cTfh cells among circulating TCD4+ cells in AMR patients was markedly elevated compared to the other groups (P < .0001). It was also higher in stable recipients than in healthy controls (P < .0001). The serum level of IL-21 was increased in AMR patients compared to stable recipients (P = .03) and healthy participants (P = .02). In addition, there was a significant negative correlation between cTfh percentage and the estimated glomerular filtration rate (eGFR) in transplanted patients (P = .001). Moreover, the AUC of cTfh cells in AMR diagnosis was 0.83 [95% CI 0.73-0.93 (P < .0001)]. Conclusion. In AMR patients, cTfh cell percentage and IL-21 levels were significantly increased. The significant association between cTfh % and eGFR, with an AUC of 0.83, indicates its potential as a diagnostic and prognostic marker in AMR.
Erratum:Trends in Research on Acute Kidney Injury: A Bibliometric Analysis of Academic Journals Published Between the Years 2000 and 2022
Copyright (c) 2024 Iranian Journal of Kidney Diseases
Scientia et Cura: Illuminating the Dark Side of CRRT for Optimal Patient Benefits
Introduction. Continuous Renal Replacement Therapy (CRRT) is commonly used in patients with hemodynamic instability but is associated with potential complications. Understanding these complications can improve CRRT efficiency and patient outcomes. Methods. This cross-sectional study investigated CRRT complications in patients > 18 years old who underwent CRRT at a tertiary medical center from 2017 to 2022. Data were collected from patient records and the hospital’s laboratory system. Results. A total of 178 patients underwent CRRT for fluid overload (38%) and non-septic acute kidney injury (AKI) (35%). The most common CRRT modalities were hemofiltration (54%) and hemodiafiltration (31%). Among patients, 76% experienced a reduction in platelet count (mean decrease of 40% ± 24). Hemoglobin declined by ≥ 1 g/dL in 58% of patients. Phosphorus decreased in 64.6% of patients (mean reduction of 33%) and potassium decreased in 50% (mean reduction of 18%), but these reductions were not statistically significant (P-values: 0.73 and 0.88). Vasopressors were stopped in 27% of patients, and the dose was reduced in 50.4%. No significant hypothermia, allergic reactions, pneumothorax, hemothorax, or air embolism were reported. The survival rate at hospital discharge was 64% (123 out of 178). Conclusion. CRRT is a safe and efficient treatment for AKI, with notable reductions in platelet count and vasopressor dependency. However, reductions in phosphorus and potassium were not significant, indicating manageable complications.
Anti-Glomerular Basement Membrane Disease Combined with IgA Nephropathy: A Case Report and Literature Review
Anti-glomerular basement membrane (GBM) disease is a rare autoimmune disease characterized by injury to small blood vessels in the kidneys and/or lungs. IgA nephropathy is the most common primary glomerular disease diagnosed in China. However, the co-occurrence of anti-GBM illness and IgA nephropathy has been infrequently documented in the literature. At present, its mechanism is unknown, the treatment approach is unclear, and the prognosis remains poor. Herein, we report a case of anti-GBM disease complicated with IgA nephropathy, in which renal function returned to normal state following treatment with a combination of prednisone and cyclophosphamide. This case suggests that in patients with anti-GBM disease and IgA nephropathy, the combination of glucocorticoids and cyclophosphamide may serve as an optimum treatment choice.
Anti-glomerular basement membrane disease
Anti- glomerular basement membrane antibody
Clinical Efficacy of High-flux Hemodialysis for Treating Uremia and its Effect on Microinflammation and Nutritional Status
Introduction. The objective of this study was to evaluate the clinical efficacy of high-flux hemodialysis for treating uremia and its effect on microinflammation and nutritional status. Methods. This was a case-control study. One hundred and twenty patients under chronic hemodialysis in Qinhuangdao Haigang Hospital from June 2021 to June 2023 were randomly divided into experiment group and control groups, with 60 patients in each group. Patients in the experiment group received high-flux hemodialysis (HFHD), while those in the control group underwent conventional hemodialysis. The differences between the two groups regarding clinical efficacy, inflammatory factors including IL-6, CRP and TNF-a, and macromolecular toxins including β2-microglobulin, parathyroid hormone, and cysteine protease inhibitor were compared. The levels of nutritional indices including serum transferrin, albumin, and hemoglobin were compared between the two groups after 6 months of therapy. All patients were followed- up for 1.5 to 2 years, and the incidence of their cardiovascular and cerebrovascular events after treatment was analyzed. Results. The response rate (markedly effective + effective)/total number of cases × 100%.) was 93% in the experiment vs. 80% in the control group (P = .03). After treatment, IL-6, CRP, TNF-a, β2-microglobulin, parathyroid hormone, and cysteine protease inhibitor significantly reduced and serum transferrin, albumin and hemoglobin significantly improved in the experiment vs. control group (P = .00). At the end of the follow-up period the incidence of cardiovascular and cerebrovascular diseases was 7% in the experiment group, which was markedly lower than that of 22% in the control group (P = .02). Conclusion. High-flux hemodialysis is a safe and effective treatment for uremia with remarkable clinical efficacy, offering various benefits such as significant reduction of inflammatory biomarkers and macromolecular toxins, improvement of patients’ nutritional status, and reduction of the incidence of cardiovascular and cerebrovascular diseases.
A Prediction Model of Early Diabetic Nephropathy Based on Conventional Ultrasound Parameters and Hematological Indices and Its Application
Introduction. Diabetic nephropathy (DN) is a chronic microvascular complication of diabetes mellitus, leading to end-stage kidney disease and increased mortality. Early detection and treatment are essential to prevent DN. This study aims to develop a diagnostic prediction model for early DN. Methods. This retrospective analysis study was conducted on 205 patients with type 2 diabetes mellitus (T2DM) treated between September 2019 and September 2022. Patients with stage A1 albumin-to-creatinine ratio (ACR) (< 30 mg/g) were categorized as the simple diabetes mellitus group (n = 134), and those with ACR 30-300 mg/g at stage A2 were classified as the early diabetic nephropathy group (n = 71). Relevant ultrasound parameters and hematological indices were selected through univariate and multivariate screenings. A nomogram model was constructed based on the results of multi-factor screening. Internal validation was performed by using Bootstrap methods with 1000 repetitions, receiver operating characteristic (ROC) curve analysis evaluated model differentiation, calibration curves verified model consistency, and decision curve analysis assessed clinical utility. Results. Multivariate logistic regression identified renal artery resistance index (RI), renal cortex shear wave velocity (SWV), Cystatin C (CysC), Retinol-binding protein (RBP), and Glycated Hemoglobin (HbA1C) as significant factors for early DN (all P < .05). The nomogram model showed good differentiation and consistency and has high clinical value and practicality in predicting DN. Conclusion. The prediction model for early DN, based on conventional ultrasound parameters and hematological indices, demonstrates good prediction efficiency and clinical practicability.
A Spatiotemporal Analysis of Hemodialysis Incidence Rate and Impact of the COVID-19 Pandemic on the End-Stage Kidney Disease Trend
Introduction. Limited research has been conducted on the spatial trend of end-stage kidney disease (ESKD), particularly hemodialysis (HD), in developing countries. This is problematic considering the growing demand for dialysis services in these regions. To bridge this research gap, this study evaluates the spatial trend of chronic dialysis incidence rates over a significant period (2007 to early 2021) in a large population, while also investigating the influence of the COVID-19 pandemic on this trend. Methods. We used data from the Shiraz University of Medical Sciences Specific Diseases Affairs database (2007-2021) on 8,368 dialysis patients. A Bayesian spatiotemporal model analyzed the data to estimate ESKD trends and relative risks with hemodialysis in 29 counties. Results. Among the patients receiving maintenance dialysis for end-stage kidney disease (ESKD), 3,348(40%) were female and 5,020(60%) were male. The average age was 57.58 ± 17, with a median age of 56 (2-98) years. The standardized incidence rate in 2007 was 0.78, while in 2020-21, it increased to 0.86. The estimated mean relative risk was 1.20, ranging from 0.43 to 4.35. We observed a consistent fixed trend with a coefficient of 0.99. During the COVID-19 pandemic and outside of it, we noticed an increased spatiotemporal interaction in the central and northern regions of the province, despite the temporal trend remaining relatively stable. Conclusion. Our study reveals previously unexplored geographic disparities in ESKD incidence within Fars province from 2007 to 2021. The notable increase in dialysis cases in the central and northern regions emphasizes the urgency of addressing this public health concern.
Effects of Nafamostat Mesilate and Systemic Unfractionated Heparin Anticoagulation on Coagulation, Renal Function, and 28-day Survival Status in Critically Ill AKI CRRT Patients
Introduction. To investigate the effect of continuous renal replacement therapy (CRRT) in patients with severe acute kidney injury (AKI) by using Nafamostat Mesilate (NM). Methods. Eighty patients with AKI who underwent CRRT from March 2022 to January 2022 were divided into control group (n = 40, treated with unfractionated heparin) and Observation group (n = 40, treated with NM). The duration of the first filter use, the number of filters used 72 hours after treatment, coagulation and renal functions, adverse reactions, bleeding events, length of stay in intensive care unit (ICU) and survival status at 28 days were compared between the two groups. Results. The observation group used the first filter for a longer period of time than the control group, and after 72 hours of treatment, the number of filters used was less than that of the control group (P < .05); Compared with before treatment, the levels of fibrinogen (FIB) and platelet count (PLT) in the observation group and control group decreased after 48 hours of treatment, while the levels of activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), and international normalized ratio (INR) increased. However, the levels of FIB and PLT in the former group were higher, while the levels of APTT, PT, TT, and INR were lower (P < .05); Compared with before treatment, the levels of creatinine (Scr), urea nitrogen (BUN), and serum cystatin C (CysC) in the observation group and control group decreased after 48 hours of treatment, and the former was even lower (P < .05); the incidence of bleeding events in the observation group was lower than that in the control group, the length of stay in ICU was shorter than that in the control group, and finally the 28-day survival rate was higher than that in the control group (P < .05). The adverse reactions of the two groups were similar (P > .05). Conclusions. NM can improve the coagulation function and renal function in patients with severe AKI undergoing CRRT, prolong the duration of the filter use, reduce the number of filters used, shorten the length of ICU stay, reduce the incidence of bleeding events, and improve the prognosis.