Tehran University Medical Journal

Background: Blood pressure decreases during sleep and is markedly increased in the morning in healthy individuals. Lack of nocturnal blood pressure fall (non-dipping) has been associated with cardiovascular morbidity, mortality and other organ damage. However, their importance in chronic renal failure is unclear. This study aimed to investigate relationship between circadian rhythm of blood pressure and renal failure severity in patients with chronic kidney disease.
Methods: This cross-section study was done in April 2016. The study population was 95 patients, more than 30 year old with hypertension and chronic renal failure. Patients were selected from clinics of two private and university hospitals affiliated to Qom University of Medical Sciences Shahid Beheshti Hospital and Vali-e-Asr Hospital, Iran. Checklist containing data such as age, sex, duration of renal failure and cause of renal failure were filled. Serum creatinine and serum urea levels were measured and entered in the checklist. The circadian rhythm of blood pressure in all patients was assessed by Holter monitoring. patients who had less than 10% decrease in blood pressure overnight were considered non-dipper and those who had 10% or more decrease in blood pressure overnight were considered dipper.
Results: Average (SD) 24-hour ambulatory systolic and diastolic of blood pressure was 136.56 (16.66) and 84.84 (10.86) mmHg, respectively. 70 patients (73.7%) had non-dipper blood pressure pattern and 25 patients (26.3%) had dipper blood pressure pattern. There was no significant difference between two groups (dipper and non-dipper) based on distribution of gender (P=0.744), age (P=0.407), serum creatinine (P=0.569), serum urea (P=0.689) and renal failure duration (P=0.812). Mean of glomerular filtration rate in dipper group was 68.64±4.13 and in non-dipper group was 65.09±16.27 (P=0.337).
Conclusion: The results of this study did not show a significant relationship between circadian rhythm of blood pressure and renal failure severity. In addition, patients with chronic renal failure showed higher rates of non-dipping pattern of blood pressure.

Background: Renal calculus with increasing prevalence and incidence in recent decades have the highest burden of urologic diseases. While preventive measures could significantly reduce the rate of recurrence, the amount of compliance with the preventive guidelines is unclear among urologists. This study was designated to evaluate the knowledge, attitude, and practice in kidney stones prevention among urologists for the first time in Iran.
Methods: This cross-sectional study was conducted on the participants of the 20th Iranian Urological Association Congress. The questionnaires included questions regarding demographics, educational and occupational information, knowledge, attitude, and practice of urologists in the field of kidney stones prevention. The questionnaires were designed according to the latest guideline of the European Association of Urology and previous studies. Scores related to the knowledge and practice were calculated based on the number of questions with correct answers. The response rate was also calculated. The correlation of knowledge and practice with background variables, including age, work experience, and time since graduation were assessed.
Results: The total response rate was 18.08% (64 out of 354 distributed questionnaires). The mean age of the respondents was 47.25±10.20 and the mean work experience was 15.61±11.70 years. The mean knowledge and practice scores were 8.36±1.48 out of 11 and 4.44±1.45 out of 7 scores, respectively. A total of 96.2% and 73.4% of the urologists earned at least half of the knowledge and practice scores, respectively. There was no significant correlation between knowledge and practice scores (P=0.706). Work experience and time since graduation had a negative relationship with the knowledge scores (respectively, P=0.02 and P=0.026), and faculty membership had a positive correlation with the practice scores (P=0.022). Most respondents had an acceptable attitude regarding the effectiveness of stone prevention.
Conclusion: Although the study participants had good knowledge, attitude, and practice pattern regarding urinary stone prevention, their performance score was less than their level of awareness. However, we could not generalize the results to other urologists due to the low response rate of the study.

Background: Pentoxifylline, a valuable medication with promising clinical characteristics and considerable profile of safety is used in many conditions namely chronic kidney diseases (CKD). However, the decision to prescribe pentoxifylline for anemia in CKD should be based on evidence accrued from randomized controlled trials (RCTs). Yet, substantial heterogeneity exists in studies performed to evaluate pentoxifylline therapy, particularly in relation to classification of patients, the different quality and research design, sample size, baseline parameters, clinical outcome measures, and definition of endpoints and clinically meaningful improvements. As a result, assessment of pentoxifylline in treating anemia of CKD by conducting a systematic review and meta-analysis of the published relevant clinical studies seems rational and promising.
Methods: The present systematic review was done in accordance with the PRISMA guideline for systematic reviews and meta-analysis. Peer-reviewed RCTs with at least four weeks of follow-up were including in the meta-analysis. Online databases (PubMed/Medline, ISI Web of Science, Embase, and Scopus) were searched to December 2017 using selected MeSH terms related to the studied topic. Data was extracted independently by two reviewers using a standard form and then cross-checked. Statistical analyses were carrying out with Stata Software, version 7.0 (Stata Corp., College Station, TX, USA). P value of less than 0.05 was considered statistically significant. Data are presented as standard mean difference (SMD) and confidence interval (CI) 95%.

Background: The mortality rate of sepsis and pneumonia is higher in end-stage renal disease (ESRD) patients than in the general population. Bacterial infections are the most common cause of hospitalization in dialysis patients and the most common source of bacteremia is vascular access in these patients. The aim of this study was to determine the prevalence of infectious causes of hospitalization in patients with end-stage renal failure in Gorgan.
Methods: This cross-sectional study was performed on patients with ESRD who were admitted to the 5 Azar Medical Education Center of Gorgan City during 2014 to 2016. Patients' information was collected through their clinical records and analyzed statistically.

Background: Immunosuppressive drugs that are widely used to prevent acute and chronic organ rejections, predispose organ transplant patients to a variety of diseases including skin problems. This study aimed to determine the prevalence of skin lesions and to investigate their association with demographic characteristics in renal transplant patients.
Methods: This cross-sectional study was performed on 100 patients who were referred to the nephrology clinic of Baqiyatallah Hospital, Tehran, Iran and underwent kidney transplantation within a year (from the first working day of the Iranian Hijri calendar in April 2015 until the last working day in March 2016). Patients were referred to a dermatologist in case of any skin lesions. Patients' data were collected in a researcher-made questionnaire and were analyzed using SPSS software, version 18. The p values less than 5% were considered to be significant.

Background: Today, with the advancement of technology in various fields, the importance of recording data in the field of health is increasing so much that for many diseases around the world, including kidney disease, registration systems have been set up. This is happening in our country and in the future, the number of these systems will increase. The medical data set contains valuable information that will be time-consuming and costly to obtain using laboratory methods, so there is a need for low-cost methods for extracting information. This study focuses on developing a predictive model for classifying the cause of kidney stones in Isfahan using three data mining techniques.
Methods: This cross-sectional research has been done from February 2021 to May 2021. The used medical data set includes information of 353 kidney stone patients in Isfahan. In this study, six target attributes of sodium, phosphate, oxalate, citrate, cysteine and uric acid were identified. The techniques for each of the 6 attributes are used separately. The techniques used in this study were three data mining techniques including random forest (RF), artificial neural network (ANN) and support vector machine (SVM).

Conclusion: Kidney stones can occur due to various reasons such as low citrate and high calcium oxalate. For example, for citrate, factors such as blood pH (potential of hydrogen), blood sugar and blood pressure are effective. To prevent any of the causes of kidney stones, factors should be controlled.

Background: Psoriasis is a chronic and recurrent inflammatory disease that involves skin, joints and different organ systems. It is associated with Multiple morbidities such as cardiovascular disorders, diabetes, hypertension, hyperlipidemia and chronic kidney disease (CKD). Due to the high importance of the association between psoriasis and CKD which results in major side effects the aim of this study was to evaluation of CKD and associated factors in Psoriasis patients at Razi Hospital, Tehran, Iran.
Methods: This retrospective study was conducted as a cross-sectional descriptive and analytical study to evaluate the frequency of CKD and associated factors in psoriatic patients admitted to the Razi Hospital whose last time of admission was from June 2018 to January 2019. According to the K/DOQI guideline, CKD is defined as the GFR<60 mL/min/1.73 m² during at least a period of three months. GFR was calculated based on the MDRD formula. The sample size was equal to 265. The hospital documents of inpatients who have been admitted to Razi Hospital wards or follow-up clinics during 2017-2019 were used for collecting information and data. This information has been extracted based on the initial checklist for data collection. Collected data has been analyzed and performed by using SPSS 25 software.
Results: The study found that 18 (6.8%) of psoriasis patients had CKD. Patients were in the age range of 3.5-92 years, the majority of them were in the age range of 18.65–79.7 years. 171 (64.5%) patients were male and 94 (35.5%) were female. 41 (15.5%) patients had diabetes, 94 (35.5%) had hyperlipidemia and 41 (15.5%) had hypertension. History of NSAID, Methotrexate, Cyclosporine, Acitretin, Infliximab, and Adalimumab medication use among 9 (3.4%), 205 (77.4%), 56 (21.1%), 147 (55.5%), 30 (11.3%), and 28 (10.6%) patients were observed, respectively. Also, 54 (20.4%) had a history of phototherapy. 217 (81.9%) of the psoriatic patients had CPP (Chronic Plaque Psoriasis) and 48 (18.1%) had PP (pustular Psoriasis) and finally, 21 (7.9%) of the patients had psoriatic arthritis.

Conclusion: The prevalence of CKD was shown to increase by age. The other correlated factors are diabetes, hypertension, and hyperlipidemia. On the other hand, there was not found any significant correlation between drugs (NSAIDs, Methotrexate, Cyclosporine, Acitretin, Infliximab, Adalimumab) and CKD prevalence. There was also no significant correlation between phototherapy, psoriasis type and psoriatic arthritis, duration of psoriasis and CKD prevalence.

Background: Information on the coronavirus infection 2019 (COVID-19) which can clinically range from asymptomatic infection to severe pneumonia, in transplant recipients is still low. Infections are a major cause of death in kidney transplant recipients, and kidney transplant recipients, like other organ recipients, appear to be more vulnerable to a variety of infections due to comorbidities and immunosuppressive drugs that predispose them to infection.
Case presentation: In this study, we reviewed 10 transplant recipients with a mean age of 50.3±11.25 years who were admitted to Ayatollah Rouhani Hospital in Babol due to COVID-19 From April 2019 to September 2019. Four patients were female and six ones were male. Fever (100%) and cough (60%) were the most common symptoms in patients. All patients used standard immunosuppressive drugs (tacrolimus, corticosteroids, mycophenolate, and cyclosporine). The mean level of oxygen saturation at the time of admission in these patients was 87.9±11.3 and in two patients with death outcomes of 57% and 95%, it was at the beginning of hospitalization. The mean leukocytes of patients at the beginning of hospitalization was10470±5784.08 per ml and the mean lymphocytes of these patients were 1081.5±516.05. In the studied patients, the mean of previous years of transplantation was 8/05±7.13 and two patients died 20 years and 5 years after their kidney transplantation. Two patients (20%), aged 57 and 50 years, died from progressive respiratory symptoms and the other eight patients recovered and were discharged from the hospital.
We reported COVID-19 infection in ten kidney transplant recipients with different clinical outcomes and periods, which may be a reference for the management of COVID-19 in such patients.
Conclusion: It seems that more information is needed to better understand the effect of anti-transplant immunosuppressive therapy on the outcome of COVID-19 infection in kidney transplant recipients. Long-term follow-up studies and more cases are needed to clarify the diagnosis, outcome, and treatment options for COVID-19 in these patients.

Case Presentation: Our report in this article is about four years old girl who went to the MRA center of Baath Hospital in Sanandaj due to flank pain in December 2019. After abdominal imaging, signs of an abnormality of the double collecting system were revealed. Abdominal and pelvic ultrasound revealed abnormalities of the UVJ, and the distal part of the right urethral duct was approximately 2 mm in size. Also, the anterior-posterior diameter of the right renal pelvis was reported to be 2 mm and the upper calyx of the right kidney was quite dilated. This incomplete integration leads to complete or incomplete forms of the renal collecting system. The prevalence of this anomaly is also mostly unilateral, but our report, in this case, is about bilateral ureters. Conclusion: We reported a rare case of bilateral Y-shaped bifid ureter, that's in this kind of anomaly 2, pyelocaliceal systems connect at the junction of the ureter to pelvic (bifid pelvis), and this abnormality was accidentally detected on ultrasound and MRI examinations. However, since duplex kidneys are often asymptomatic and therefore mainly diagnosed incidentally in patients, the actual number of patients with symptoms is probably lower.

Background: Due to the fact that various factors are involved in the development of chronic kidney disease, this disease appears with different clinical and laboratory symptoms. The variety in type and number of clinical symptoms often misguides the treating physician. The aim of this study is to extract the key features of the disease and find the best data mining methods to improve the accuracy of kidney disease diagnosis.
Methods: This cross-sectional study was conducted from September 2021 to March 2023 for 30 months at Rafsanjan Ali Ebn Abi Taleb Hospital. Predictive models were developed and tested using different combinations of disease characteristics and seven data mining methods in RapidMiner Studio software. The limitations of the study are as follows: 1) The models were based on 40-year-old and older patients records, which may limit the generalization of results to a wider age group. 2) Despite the high accuracy and comprehensiveness of the method, the models were based only on the information of kidney disease patients at Ali Ibn Abi Talib Rafsanjan Hospital. 3) The climate parameter has not been considered in the data set of the investigation to discover the hidden relationships of this parameter with the kidney disease.

Results: The results of the experiments in this study showed that the proposed prediction model using the Bayes method and eight identified key features (age, renal biopsy, uremia, sedimentation, albumin, edema, nocturnal enuresis, and urine-specific gravity), can detect kidney disease in people of different clinical characteristics, with 99.38% accuracy. Conclusion: Considering that the early diagnosis of kidney disease and the adoption of appropriate treatment methods can prevent the progression of kidney damage, in this study, an attempt has been made to achieve this goal by using new statistical methods and artificial intelligence techniques. Based on the proposed method and the conducted experiments, the most important features and the best data mining method were obtained, and finally, kidney disease prediction was possible with high accuracy.

Background: Mesenchymal stem cell (MSC) transplantation is a promising therapy for kidney repair. This study compared the regenerative effects of feline MSCs (fMSCs) and telmisartan, a renin-angiotensin blocker (RAB), in a feline model of chronic kidney disease (CKD).
Methods: The fMSCs were obtained from 35 Persian cats with CKD and characterized by CD44, CD90, and CD105 markers by using real-time RT-qPCR. The cats were randomly allocated to four groups, fMSCs injection (first group), telmisartan administration (second group), no treatment (third group), and healthy controls (fourth group). The study was conducted in Kerman province from December 2018 to December 2019. The factors that may affect the risk of CKD, such as age, weight, and history of kidney diseases, were considered as independent variables. The presence or absence of CKD was the dependent variable. The cats were followed up for 120 days and evaluated by physical examination, glomerular filtration rate (GFR), blood urea nitrogen (BUN), serum creatinine (SCr), serum urea, alanine transaminase (ALT), urine specific gravity (SG), and kidney histopathology. Statistical analysis was performed using SPSS software (version 20) with two-way ANOVA and Tukey test. P<0.05 was considered statistically significant.

Results: The fMSCs group showed significant improvement in GFR, BUN, SCr, serum urea, SG, and kidney histology compared to the other groups. The fMSCs group also showed increased expression of CD44, CD90, and CD105 genes in the kidney tissue, indicating enhanced stem cell activity. The telmisartan group showed modest improvement in blood pressure and proteinuria, but no significant effect on other parameters. fMSCs transplantation can restore the kidney function and structure in cats with CKD by modulating the apoptosis and proliferation of renal cells. The telmisartan  patients benefited from the anti-hypertensive and anti-proteinuric effects of the drug, but not from its anti-fibrotic or anti-inflammatory effects. Conclusion: fMSCs transplantation was more effective than telmisartan in improving kidney function and reducing kidney damage in cats with CKD. fMSCs may be a potential therapeutic option for CKD patients.

Background: Studies of viral pandemics in the past, as well as studies of patients with sepsis, have shown that there is a direct relationship between the occurrence of AKI with disease severity and mortality, prognosis and outcomes. Considering that the COVID-19 disease is a novel pandemic and there is not enough information on the occurrence of AKI with COVID outcomes and its consequences, especially in Iran, it is necessary to conduct research in this field.
Methods: This is a retrospective study on 310 Covid patients hospitalized in the internal medicine, critical care and infectious disease ward of Birjand Valiasr Hospital from 20 March 2020 until 20 March 2021. Data were collected from the hospital's health information unit. The information was collected including demographics, underlying diseases, vital signs, laboratory information, and imaging and type of respiratory support. Finally, data was analyzed by SPSS V.22.

Results: 310 patients with an average age of 51.9 ± 17.4 participated in this study, 58.4% of them were male. The prevalence of acute kidney injury in patients was 7.4%. There was a significant relationship between acute kidney injury and the COVID severity, so that the COVID severity increases with the occurrence of acute kidney injury. There was a significant relationship between COVID outcomes and acute kidney injury, so that a higher mortality rate was observed in patients with acute kidney injury. No significant relationship was found between the occurrence of acute kidney injury and the score of pulmonary involvement. Patients with hypertension were more tent to experience acute kidney injury. Also, patients with acute kidney injury have more leukocytosis compared to patients without acute kidney injury. In this study, no significant relationship was observed between lymphocyte count and acute kidney injury. This study showed that the level of serum CRP and BUN are significantly higher in patients with acute kidney injury.

Background: A range of diseases can result in end-stage renal disease (ESRD), characterized by a gradual decline in kidney function and associated with significant morbidity and mortality. Currently, renal transplantation as the most effective treatment for managing ESRD. Tissue engineering presents a considerable opportunity to expand the available supply of donor organs for kidney transplants. The aim of this research was to develop a suitable technique for preparing decellularized kidney scaffolds from human tissues.
Methods: The present study was carried out from April 2019 to August 2019 in Mashhad University of Medical Sciences. In this study, two decellularization protocols were compared using sections of human kidney tissue. Therefore, two human kidneys which collected from Ghaem and Imam Reza hospitals were used. In the first protocol, detergents such as 1% Triton X-100 (1A) and 1% SDS (Sodium Dodecyl Sulfate) (1B) were employed, followed by the application of DNase I. The second protocol utilized 0.5% SDS (2A) and 1% SDS (2B). The effectiveness of these techniques was evaluated using hematoxylin and eosin (H&E) staining, 4',6-diamidino-2-phenylindole (DAPI), DNA quantification, and immunohistochemistry (IHC).

Results:  Based on H&E staining results, comparison of the decellularized and native human kidney tissues showed a successful elimination of cell nuclei and the ameliorate extracellular matrix preservation in triton-treated scaffolds (1A) in comparison with the SDS-treated scaffolds (1B) at all times protocols. Furthermore, DNA quantification illustrated triton X-100 in removing DNA was more effective in eliminating DNA from kidney tissues compared to other protocols in renal tissues. In addition, IHC staining demonstrated that the expression of collagen IV and laminin was preserved throughout the decellularization process with Triton X-100 on day fifth. Also, IHC staining indicated human leukocyte antigen (HLA) was completely eliminated in the cortex-medulla of human scaffolds treated with Triton X-100 within day fifth. Conclusion: Our results demonstrated that triton X-100 outperformed SDS as a detergent for decellularizing human kidneys. Meanwhile these results indicate suitable method for decellularization of human kidneys to produce functional kidneys.

Background: Diabetic kidney disease is a common complication of diabetes and the most common cause of end-stage kidney disease worldwide. Empagliflozin is associated with slower progression of kidney disease and a lower incidence of kidney complications. So, the aim of the study is to compare renal outcomes in type 2 diabetic patients with and without empagliflozin.
Methods: This research is a cross-sectional study based on the information contained in the files of patients referred to Imam Khomeini and Golestan hospitals in Ahvaz in 1400-1401. Inclusion criteria included age over 18 years, type 2 diabetes, HGA1c less than or equal to 9, GFR between 30 and 60 ml/min/1.73 m2, use of empagliflozin for more than or equal to three months, and urinary albumin to creatinine ratio greater than 30 mg/dL. Exclusion criteria included patients not attending the clinic for follow-up during the study, proteinuria due to glomerulonephritis, type 1 diabetes, vaginitis, UTI, and liver failure based on history.
Based on this, 136 people with type 2 diabetes were included in the study and were randomly divided into two drug and control groups, one group of patients who took empagliflozin for three months and the other group of patients who did not receive this treatment. Patient data, including serum creatinine, HBA1C, albuminuria, weight, blood pressure, side effects, were extracted and then the patients' data were collected three and six months after receiving empagliflozin. Data analysis was done with descriptive and analytical statistics.
Results: In this study, 56 (41.2%) were male and 80 (58.8%) were female. Changes in eGFR (P=0.044) and (P=0.003), HbA1C (P=0.014), albuminuria (P=0.001) during 3 months and 6 months, and changes in systolic blood pressure (0.020) during 3 months between the empagliflozin group were significantly different compared to the control group. However, there was no significant difference between the two groups in terms of weight changes during 3 months and 6 months (P=0.97) and changes in systolic blood pressure during 6 months (P=0.13).
Conclusion: Using empagliflozin can improve kidney function and reduce albuminuria.

Background: Clear renal cell carcinoma (ccRCC) is the most common malignant kidney tumor and has a high mortality rate. The pathogenesis of this cancer is complex and efficient biomarkers for its diagnosis and prediction are limited. This study aimed to identify predictive genes in ccRCC through analysis and laboratory validation ccRCC is the most common malignant kidney tumor and has a high mortality rate.
Methods: The present study was a case-control study in which samples were taken from patients and healthy individuals from Labafi Nejad Hospital in Tehran between October 2012 and April 2014, and laboratory tests were performed on the samples.
First, genes with differential expression in ccRCC patients were identified by bioinformatics using gene expression profile data from the Gene Expression Omnibus (GEO) database with accession number GSE213324. Data analysis was performed using Galaxy web server, protein-protein interactions were checked using Cytoscape and STRING app software, and finally two genes were selected for real-time PCR testing.

Results: Analysis identified 4,065 genes with differential expression in RCC tissues compared to healthy tissues. These genes are involved in immune responses and renal disease pathways, suggesting their potential role in disease development. After constructing the protein-protein interaction network and identifying differentially expressed genes in kidney tissue and blood, two genes, MTTP and CALCA, were selected for further investigation. In the Mann-Whitney U test, the expression of the CALCA gene decreased significantly in the patient group (P<0.05). On the other hand, the MTTP gene showed a decrease in expression, but not significantly. The AUC calculated to evaluate the diagnostic accuracy for the CALCA gene was 0.64 and significant (P<0.05), demonstrating its potential as a useful biomarker for ccRCC diagnosis. However, the AUC for the MTTP gene was not significant. Conclusion: The reduction in CALCA expression could serve as a useful biomarker for diagnosing ccRCC.

Background: Posterior urethral valve (PUV) is recognized as one of the most frequent causes of obstructive uropathy in the pediatric population, particularly in male infants. This congenital anomaly leads to variable degrees of urinary outflow obstruction, which may result in progressive renal damage and deterioration of kidney function over time. Despite advances in diagnostic modalities and surgical interventions, infants and children affected by PUV continue to demonstrate suboptimal long term renal outcomes, with a considerable proportion developing chronic kidney disease (CKD). Understanding early predictors of adverse renal prognosis is essential to guide timely interventions and optimize follow up strategies. The present study aimed to assess the long term renal outcomes, over a minimum of five years, of patients with PUV treated at the Children’s Medical Center, and to investigate the role of preoperative serum creatinine levels as a predictor of future CKD in this patient group.
Methods: A cross sectional and retrospective study design was employed. The medical records of patients diagnosed with PUV between March 2011 and March 2016 who had at least five years of documented follow up were reviewed at the Children’s Medical Center in 2021. Data extracted included demographic characteristics, laboratory tests—particularly pre and post operative serum creatinine—ultrasound imaging results, surgical details, and follow up findings throughout the study period.
Results:  Eighty one patients met the inclusion criteria, with a mean age at diagnosis of 105 days. At the five year follow up, the overall prevalence of CKD among these patients was estimated at approximately 9.9%. During the follow up period, one patient died due to kidney disease, one underwent kidney transplantation, and three required maintenance dialysis. Statistical analysis demonstrated that a preoperative creatinine level exceeding 1.15 mg/dL was strongly associated with the future development of CKD, showing 100% sensitivity and 75% specificity in predicting adverse long term renal outcomes.
Conclusion: This study underscores the persistent risk of CKD in children with PUV, even after surgical intervention. Regular and comprehensive monitoring of renal function remains vital in this high risk group. Preoperative serum creatinine may serve as a reliable, accessible, and clinically useful prognostic marker to identify patients who may benefit from closer follow up and proactive management strategies.
 

Background: Asymptomatic hypotension is a common complication in patients undergoing hemodialysis, which can lead to serious consequences. Troponin I, as a biochemical marker for myocardial injury, may play a role in the diagnosis and management of this complication. This study aimed to investigate the relationship between serum troponin I level changes and asymptomatic hypotension in patients with advanced kidney failure undergoing hemodialysis.
Methods: In this cross-sectional study, 120 adult ESRD patients (aged 30–80 years) with an ejection fraction (EF) >50% who attended the hemodialysis unit of Shohada Tajrish Hospital over a 6-month period starting 15 January 2024 were enrolled. Demographic and clinical data were collected using a checklist. Serum troponin I levels were measured before and after dialysis, and patients' blood pressure was recorded throughout dialysis sessions. For quantitative variables, mean and standard deviation were reported; for qualitative variables, absolute and relative frequencies were presented. Statistical analysis was performed using the Paired t-test, Independent t-test, Pearson correlation coefficient, and their non-parametric equivalents as appropriate. A significance level of p < 0.05 was considered statistically significant.
.Results: A total of 120 patients were examined, with a mean age of 57.6 ± 7.1 years. The gender distribution was 67 males (55.8%) and 53 females (44.2%). The mean body mass index was 20.73 ± 0.98. Significant differences were found in mean blood pressure, heart rate, body weight, and changes before and after dialysis (P<0.05). These differences included a decrease in blood pressure, and body weight, an increase in heart rate, and an increase in troponin levels. No significant relationship was found between troponin changes before and after dialysis with age, gender, height, weight, body mass index, heart rate, average duration of dialysis, and other laboratory variables (P>0.05). However, a significant correlation was found between troponin changes and blood pressure changes, indicating that as troponin levels increased, the mean blood pressure of patients decreased.
Conclusion: The findings of this study indicate a significant relationship between increased serum troponin I levels and asymptomatic hypotension in patients with advanced kidney failure undergoing hemodialysis. These results may be useful in identifying at-risk patients and improving therapeutic management. Further research is needed to confirm this relationship and explore its underlying mechanisms.
 

Background: Cisplatin is one of the most effective chemotherapy agents; however, its nephrotoxicity remains the primary dose-limiting factor. This study aimed to determine the prevalence and clinical course of acute kidney injury (AKI) in patients receiving high-dose cisplatin therapy.
Methods: This cross-sectional descriptive study was conducted at Ayatollah Khansari Hospital in Arak, based on clinical records of hospitalized patients from March 2021 to June 2022. Patients who received at least four cycles of cisplatin-based chemotherapy at a dose of 260 mg/m² were included. Data were extracted from the Hospital Information System (HIS) and physical records. Ninety eligible cases were selected via random sampling. Data were summarized using descriptive statistics.
Results:  Regarding gender distribution, 54.4% were female (n=49) and 45.6% were male (n=41). The relative frequency of cisplatin-induced AKI was 21.11%. Overall, 26.32% of patients developed chronic kidney disease (CKD), 10.53% reached end-stage renal disease (ESRD), and only 11.42% recovered. An 18 to 24-month follow-up revealed a mortality rate of 21.05%, while 15.79% required treatment modification, and 5.26% needed kidney transplantation. No treatment discontinuation was observed. Logistic regression analysis identified female gender, age 61-70, age >70, poor hydration status, five or more chemotherapy cycles, and diabetes mellitus as significant risk factors for AKI.
Conclusion:  High-dose cisplatin is associated with a high risk of permanent renal damage. Given the low recovery rate and the potential for progression to chronic renal failure, careful monitoring of risk factors and rigorous hydration management are vital for these patients.