Abnormal Kidney Research Articles

Study on the Changes of Liver and Kidney Function-Related Indicators and Clinical Significance in Patients with OSAHS.

Purpose To study the changes of liver and kidney function-related indexes in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and analyze their clinical significance. Method Ninety OSAHS patients treated in our hospital from April 2019 to April 2021 were selected. According to the apnea-hypopnea Index (AHI), they were divided into mild OSAHS group (5 ≤ AHI < 15 times/h, 35 people), moderate OSAHS group (15 ≤ AHI < 30 times/h, 35 people), and severe OSAHS group (AHI ≥ 30 times/h, 20 people). In addition, 50 healthy people who underwent physical examination in our hospital at the same time were selected as the control group, and the liver and kidney function and polysomnography (PSG)-related indexes of the above subjects were detected, and the comparison between the groups was carried out. Result The serum BUN and SCR levels of the severe group were significantly higher than those of the moderate group, the moderate group had significantly higher levels than the mild group, and the mild group had significantly higher levels than the control group (P < 0.05). The blood AST level of the severe group was significantly lower than that of the moderate group, the moderate group had a significantly lower level than the mild group, and the mild group had a significantly lower level than the control group (P < 0.05). The blood ALT level of the severe group was significantly higher than that of the moderate group, the moderate group had significantly a higher level than the mild group, and the mild group had a significantly higher level than the control group (P < 0.05). The proportions of abnormal liver and kidney function in the control group, mild group, moderate group, and severe group were significantly different (P < 0.05). The AHI of the severe group was significantly higher than that of the moderate group, the moderate group had a higher value than the mild group, and the mild group had a higher value than the control group (P < 0.05). The ASpO2 and MSpO2 of the severe group were significantly lower than those of the moderate group, the moderate group had significantly lower values than the mild group, and the mild group had significantly lower values than the control group (P < 0.05). Spearman correlation analysis showed that the liver and kidney function indexes of OSAHS patients were significantly correlated with PSG indexes (P < 0.05). Conclusion Patients with OSAHS will have obvious liver and kidney dysfunction, and the monitoring of liver and kidney function in such patients should be strengthened. If abnormality occurs, early intervention is recommended.

Genetic Basis of Congenital Anomalies of Kidney and Urinary Tract

Congenital anomalies of kidney and urinary tract (CAKUT) is a group of abnormalities affecting the kidneys or other structures of the urinary tract that include ureters, urinary bladder and urethra. CAKUT include renal agenesis or hypodysplasia, multicystic dysplastic kidney, ureteropelvic junction obstruction, duplication of the pelvis, ureter, and/or kidney, congenital megaureter, ureterovesical junction obstruction, vesicoureteral reflux and posterior urethral valves. Those results from abnormal development of the urinary system and is present from birth (congenital), although the abnormality may not become apparent until later in life. The clinical spectrum of CAKUT has significant impact on long-term patient survival. We observed that the causes of CAKUT are complex, usually combination of genetic and environmental factors contribute to the developmental abnormalities of kidney and urinary tract in foetus. The genetic factors involved in most cases of CAKUT are unknown; however, syndromic CAKUT is caused by changes in the genes associated with the particular syndrome. Variations in the same genes can also underlie some cases of isolated CAKUT. This review paper aims to discuss genetic basis of CAKUT, i.e., identifying different genes involved in syndromic and non-syndromic CAKUT. Modern genetic testing facilities can provide a precise diagnosis that can help individualize clinical care by screening for specific complications, facilitate medical decision making, and provide better genetic counseling.&#x0D; CBMJ 2022 January: vol. 11 no. 01 P: 69-74

AN IMPROVED BUTTERFLY-NET BASED DETECTION OF STONES IN KIDNEY IMAGES

Kidney stone disease is one of the major life threatening problem existing worldwide. It is important to recognize the true and exact location of kidney stone. The ultrasound images of kidney comprise speckle noise and are of low contrast which makes the identification of kidney abnormalities a challenging task. Thus, the doctors may find recognition of small stones difficult. Butterfly-net model is a low-complexity convolutional neural network with sparse cross channel connections and with pre-processing techniques for kidney stone detection. IntegratingSerious problems are well approximated with network complexity based on frequency bandwidth rather than input dimension using a butterfly-net with a fully connected neural network. The proposed Butterfly-net obviously embraces the arranged construction in the Butterfly plot as the stacked convolutional layers. In the event that the boundaries are hard-coded as that in the Butterfly plot, Butterfly-net on the whole registers the Fourier coefficients of the info signal with ensured mathematical exactness. Keywords:Butterfly-Net , Kidney Stone, Deep Learning.

Histopathological Assessment of Organ Impairment of Rattus albus Treated with Selected Medicinal Plants

A histopathological assessment of organ impairment of Rattus albus treated with selected plant extracts: (Napleonaea imperalis, Sida acuta and Vernonia amygdalina) was studied from October 2014 to March 2016. The aim of the study was to determine the histopathological effects of the plant extracts on Rattus albus. The Rattus albus were treated with 3 selected plant extracts: Vernonia amygdalina, Sida acuta and Napoleonae imperialis and observed for 3 weeks. A total of 22 male and 23 female laboratory animals were selected and treated with plant extracts and reference drugs. The different treatment groups and controls were selected for histopathological studies using paraffin wax embedding method.They were sacrificed and examined histopathologically for pathological features. The results showed that, all 3 selected plant extracts contain Tanins, Saponins, Alkaloids, Flavonoids, Cardiac Glycosides, Phytate, Oxalate, Phenol, Steroids, Terpenoids and Cyanide. Out of 4 laboratory animals in each group treated with 10µg of crude Napoleonea imperialis,Sida acuta and Vernonia amygdalina extracts, no feature of impairment was observed in the intestine, kidneys and liver of all the laboratory animals used. Out of 4 laboratory animals in each group treated with 20µg of crude Napoleonea imperialis extract, the intestine and liver of one each showed features of impairment. Out of 4 laboratory animals treated with 20µg of crude Sida acuta extract, the intestine, kidney and liver of one animal each showed features of impairment. Out of 4 laboratory animals treated with 20 µg of crude Vernonia amygdalina extract, no impairment was observed in the intestine, kidneys and liver of all laboratory animals used. Out of 4 laboratory animals treated with 30 µg of crude Napoleonea imperialis extract, the intestine of 1, the kidney of 1 and livers of 2 showed features of impairment. Out of 4 laboratory animals treated with 30 µg of crude Sida acuta extract, the intestine of 2, kidney of 1 and livers of 2 showed features of impairment. Out of 5 laboratory animals treated with 30 µg of crude Vernonia amygdalina extract, the intestine of 1, the kidneys 1 and livers of 2 showed features of impairment.Organ impairment on laboratory animals due to plant extract shows that, out of 12 animals (6 males and 6 female laboratory animals) treated with Napoleoneae imperialis 10 (83.3%) had normal intestine and 2 (16.7%) had abnormal intestine, 11 (91.7%) had normal kidneys, 1 (8.3%) had abnormal kidney, 9 (75%) had normal liver and 3 (25%) had abnormal liver (Table 2). Out of 12 laboratory animals (6 male and 6 female laboratory animals) treated with Sida acuta 9 (75%) had normal intestine and 3 (25%) had abnormal intestine, 10 (83.3%) had normal kidneys, 2 (16.7%) had abnormal kidney, 9 (75%) had normal liver and 3 (25%) had abnormal liver. Out of 13 laboratory animals (6 male and 7 female laboratory animals) treated with Vernonia amygdalina, 12 (92.3%) had normal intestine and 1 (7.7%) had abnormal intestine, 12 (92.3%) had normal kidneys, 1 (7.7%) had abnormal kidney, 11 (84.6%) had normal liver and 2 (15.4%) had abnormal liver. Analysis of the data using chi square showed significant difference (p &lt; 0.05) in the frequency of organ impairments between the different organs of the laboratory animals. The highest frequency of impairment was observed on the liver followed by intestine and the least impairment was on the kidneys. Three types of impairment: inflammatory changes, degenerative changes and distortions were observed on the intestine of the laboratory animals. On the kidneys, 5 types of impairment: lymphocytic infiltration, degenerative changes, necrosis, vacuolation, and distortion of stroma and glomerulus were observed. On the liver, 4 types of impairment: inflammatory changes, hepatocytic degernerative changes, necrosis and distortion of hepatocytes were observed. Whereas the frequency of impairment was higher in liver organs 9 (20.0%) than kidneys 4 (8.9%), the types of impairment observed were higher in kidneys than liver organs. This study has shown that Napoleonae imperialis, Sida acuta and Vernonia amygdalina extracts at higher concentration, exhibit pathologic effects on host organs: intestine, kidney and liver.

Effects of a Cordyceps militaris With Herba epimedii Complex on Chronic Renal Failure Induced by Adenine in vivo

In this paper, the relieving effects of Cordyceps militaris and Herba epimedii complex on chronic renal failure (CRF) induced by adenine were investigated. The CRF model with severe damage to kidney tissue and abnormality of physiological and biochemical indices was established by administrating Sprague Dawley male rats daily with adenine (250 mg/kg). After treatments with the complex, the levels of serum creatinine ( P &lt; .001), urea nitrogen ( P &lt; .001), uric acid ( P &lt; .001), and P3+ ( P &lt; .01) were significantly decreased, while the levels of estradiol (E2), luteinizing hormone ( P &lt; .001), nitrite oxide ( P &lt; .001), and Ca2+ ( P &lt; .001) were significantly increased. The damage to kidney tissue of CRF rats was obviously ameliorated. All the treatment groups showed therapeutic effects of CRF induced by adenine. The Cordyceps militaris and Herba epimedii complex showed the best effect at the dose of 10.4 + 10.4 mg/kg/d.

Neonatal Circumcision in Boys With Posterior Urethral Valves

Source: Harper L, Blanc T, Peycelon M, et al. Circumcision and risk of febrile urinary tract infection in boys with posterior urethral valves: result of the CIRCUP randomized trial. Eur Urol. 2022;81(1):64-72; doi:10.1016/j.eururo.2021.08.024Investigators from multiple institutions in France conducted a randomized controlled trial to assess the effect of circumcision on the risk of febrile urinary tract infection (fUTI) in infant boys with posterior urethral valves (PUV). Participants were male neonates 1-28 days old with PUV diagnosed by voiding cystogram, who were enrolled between 2012 and 2017 at 13 pediatric urology centers. Study patients were randomized to circumcision and antibiotic prophylaxis (CATB), or antibiotic prophylaxis alone (ATB) treatment groups. Circumcision was performed at the time of valve resection under general anesthesia. Antibiotic prophylaxis consisted of cefaclor 10 mg/kg/day for 1 month, followed by cotrimoxazole (15 mg/kg/day) until participants were 2 years old. A technetium-99m dimercaptosuccinic acid (DMSA) scan was performed when patients were 1-2 months and 2 years of age to evaluate renal damage. Study children were followed for 2 years. The primary outcome was fUTI, defined as culture-proven infection (≥103 bacteria/mL in catheterized specimens and ≥104 bacteria/mL for urine specimens obtained by suprapubic aspiration) with pyuria, in the presence of fever (>38.5° C) and signs of inflammation (leukocytosis, elevated C-reactive protein, and/or procalcitonin). The risk of fUTI in the 2 treatment groups was assessed using Kaplan-Meier analysis, and Cox regression was used to compare the risks. Adherence to antibiotic prophylaxis was assessed throughout the 2-year follow-up period and compared between groups. Evidence of increased renal damage between the initial and follow-up DMSA scans was determined and compared in those with and without fUTI with a chi-square test.Data were analyzed on 91 boys, including 49 randomized to CATB and 42 to the ATB group; the mean age at enrollment was 4.3 ± 5.0 and 7.1 ± 6.7 days, respectively, and mean age at valve resection was 5.2 ± 5.4 and 9.4 ± 11.6 days, respectively. A total of 64 (70%) children completed the entire 2-year follow-up period (33 in the CATB group and 31 in the ATB group). Overall, the risk of fUTI was 20% in the ATB group and 3% in those randomized to circumcision (hazard ratio [HR], 10.3; 95% CI, 1.3, 82.5). Adherence to the antibiotic prophylaxis regimen declined in participants during the study period but was not significantly different between treatment groups. At the time of the initial DMSA scan, 63% of children had abnormalities identified, and deterioration on DMSA scans was noted on 18% at follow-up, including 33% of those with a history of fUTI and 16% without fUTI (P = 0.29).The authors conclude circumcision decreased the risk of fUTI in boys born with PUV.Dr Sanchez-Kazi has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The prevalence of fUTI is highest during the newborn period in boys with PUV.1 fUTI increases the risk of renal scarring, which can lead to chronic kidney disease. (See AAP Grand Rounds. 2019;42(5):53.)2 The current investigators evaluated whether circumcision reduces the risk of fUTI in boys with PUV. Although the results showed that CATB lowered the risk of fUTI, there was no difference between groups in the degree of kidney scarring as shown on the DMSA scans. Although it may be possible that this lack of significant change is explained by a lower number of participants, high attrition rate, variability in the radiographic interpretation of the DMSAs, short period of follow-up, or the inherent abnormal kidney parenchyma in boys with PUV due to possible dysplasia. However, the most likely explanation is that despite a substantial effect size (the rate of worsening DMSA scans was >2 times higher in those with fUTI than those without), there was insufficient power to detect a statistically significant difference in the outcomes.As stated in the accompanying editorial, circumcision reduced the occurrence of fUTI, but it did not decrease morbidity or mortality related to kidney scars.3 Steroid cream is currently used to manage phimosis in uncircumcised infants with fUTI.4 Will a retractable foreskin have the same advantage in infants with PUV?4 In boys with PUV however, neurogenic bladder and hydronephrosis are additional factors that significantly increase the probability of fUTI.1 In the most recent AAP Policy Statement on Circumcision in boys with a normal urinary tract, the committee left the decision-making to parents.5 The Canadian Urological Association also recommends early parental discussion of circumcision in the presence of an abnormal urinary tract including PUV, since the risk of fUTI is highest within the first 3 months of life.1,6 The results of the current study hopefully will contribute to more knowledgeable parental decision making.Neonatal circumcision in boys with posterior urethral valve decreases the risk of fUTI.

Intensive blood pressure control and cognitive impairment in chronic kidney disease: The jury is still out

Globally, 55 million people suffer from dementia, mainly Alzheimer's disease (60–70% of cases), and over 60% of patients live in low- or middle-income countries. This number is estimated to rise to 78 million in 2030 and 139 million in 2050, and over 70% of new cases will occur in poorer countries, with huge socioeconomic costs for affected individuals, their relatives, and governments [ [1] World Health Organization SGGlobal action plan on the public health response to dementia 2017–25. 2017; (Available at https://www.who.int/publications/i/item/global-action-plan-on-the-public-health-response-to-dementia-2017-2025 Accessed on 08/05/2022) Google Scholar ]. People with chronic kidney disease (CKD), as defined by an estimated glomerular filtration rate [eGFR] lower than 60 mL/min/1.73 m2, or eGFR ≥ 60 plus a marker of kidney damage (albuminuria, abnormal kidney ultrasound scan, etc.) [ [2] Stevens P.E. Levin A. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013; 158: 825-830 Crossref PubMed Scopus (1475) Google Scholar ] have a significantly higher risk for cognitive impairment compared to the general population [ [3] Drew D.A. Weiner D.E. Sarnak M.J. Cognitive impairment in CKD: pathophysiology, management, and prevention. American Journal of Kidney Diseases. 2019; 74: 782-790 Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar ]. As the global prevalence of CKD is as high as 13.4% (i.e. over 700 million people) [ [4] Hill N.R. Fatoba S.T. Oke J.L. Hirst J.A. O’Callaghan C.A. Lasserson D.S. et al. Global prevalence of chronic kidney disease - a systematic review and meta-analysis. PLoS ONE. 2016; 11 (e0158765-e) Crossref Scopus (1572) Google Scholar ], it is hardly surprising that there is a great interest in the primary and secondary prevention of dementia worldwide.

Novel Biomarkers of Kidney Disease in Advanced Heart Failure: Beyond GFR and Proteinuria.

Kidney disease is a common finding in patients with heart failure and can significantly impact treatment decisions and outcomes. Abnormal kidney function is currently determined in clinical practice using filtration markers in the blood to estimate glomerular filtration rate, but the manifestations of kidney disease in the setting of heart failure are much more complex than this. In this manuscript, we review novel biomarkers that may provide a more well-rounded assessment of kidney disease in patients with heart failure. Galectin-3, ST2, FGF-23, suPAR, miRNA, GDF-15, and NAG may be prognostic of kidney disease progression. L-FABP and suPAR may help predict acute kidney injury (AKI). ST2 and NAG may be helpful in diuretic resistance. Several biomarkers may be useful in determining prognosis of long-term kidney disease progression, prediction of AKI, and development of diuretic resistance. Further research into the mechanisms of kidney disease in heart failure utilizing many of these biomarkers may lead to the identification of therapeutic targets.

Global prevalence of occult hepatitis C virus: A systematic review and meta-analysis.

BACKGROUNDOccult hepatitis C infection (OCI) is characterized by the presence of hepatitis C virus (HCV) RNA in the liver, peripheral blood mononuclear cells (PBMC) and/or ultracentrifuged serum in the absence of detectable HCV-RNA in serum. OCI has been described in several categories of populations including hemodialysis patients, patients with a sustained virological response, immunocompromised individuals, patients with abnormal hepatic function, and apparently healthy subjects.AIMTo highlight the global prevalence of OCI.METHODSWe performed a systematic and comprehensive literature search in the following 4 electronic databases PubMed, EMBASE, Global Index Medicus, and Web of Science up to 6th May 2021 to retrieve relevant studies published in the field. Included studies were unrestricted population categories with known RNA status in serum, PBMC, liver tissue and/or ultracentrifuged serum. Data were extracted independently by each author and the Hoy et al tool was used to assess the quality of the included studies. We used the random-effect meta-analysis model to estimate the proportions of OCI and their 95% confidence intervals (95%CI). The Cochran's Q-test and the I2 test statistics were used to assess heterogeneity between studies. Funnel plot and Egger test were used to examine publication bias. R software version 4.1.0 was used for all analyses.RESULTSThe electronic search resulted in 3950 articles. We obtained 102 prevalence data from 85 included studies. The pooled prevalence of seronegative OCI was estimated to be 9.61% (95%CI: 6.84-12.73) with substantial heterogeneity [I² = 94.7% (95%CI: 93.8%-95.4%), P < 0.0001]. Seropositive OCI prevalence was estimated to be 13.39% (95%CI: 7.85-19.99) with substantial heterogeneity [I2 = 93.0% (90.8%-94.7%)]. Higher seronegative OCI prevalence was found in Southern Europe and Northern Africa, and in patients with abnormal liver function, hematological disorders, and kidney diseases. Higher seropositive OCI prevalence was found in Southern Europe, Northern America, and Northern Africa.CONCLUSIONIn conclusion, in the present study, it appears that the burden of OCI is high and variable across the different regions and population categories. Further studies on OCI are needed to assess the transmissibility, clinical significance, long-term outcome, and need for treatment.

USP40 deubiquitinates HINT1 and stabilizes p53 in podocyte damage

Podocyte damage is a major pathological lesion leading to focal segmental glomerulosclerosis (FSGS). Podocytes damaged by cellular stress undergo hypertrophy to compensate for podocytopenia. It is known that cyclin-dependent kinase inhibitors induced by p53 ensure podocytes hypertrophy; however, its precise mechanism remains to be further investigated. In this study, we found that ubiquitin specific protease 40 (USP40) is a novel regulator of p53. Although USP40 knockout mice established in the present study revealed no abnormal kidney phenotype, intermediate filament Nestin was upregulated in the glomeruli, and was bound to and colocalized with USP40. We also found that USP40 deubiquitinated histidine triad nucleotide-binding protein 1 (HINT1), an inducer of p53. Gene knockdown experiments of USP40 in cultured podocytes revealed the reduction of HINT1 and p53 protein expression. Finally, in glomerular podocytes of mouse FSGS, upregulation of HINT1 occurred in advance of the proteinuria, which was followed by upregulation of USP40, p53 and Nestin. In conclusion, USP40 bound to Nestin deubiquitinates HINT1, and in consequence upregulates p53. These results provide additional insight into the pathological mechanism of podocyte hypertrophy in FSGS.

Genetic diagnosis of common fetal renal abnormalities detected on prenatal ultrasound

This retrospective study aimed to investigate the correlations between phenotypes of fetal renal abnormalities on prenatal ultrasound and genetic aetiologies detected using chromosomal microarray analysis (CMA) and whole-exome sequencing (WES). Fetuses with renal abnormalities were subjected to CMA and were further analysed by WES when CMA-negative. The detection rates for chromosomal abnormalities and monogenic variants among different types of isolated renal abnormalities and those with extrarenal abnormalities (non-isolated cases) were determined and compared. CMA detected chromosomal abnormalities in 78 of 577 fetuses (13.52%). WES detected monogenic variants in 31 of 160 fetuses (19.38%) that had non-diagnostic CMA results. In cases of isolated hyperechogenic kidney, polycystic kidney disease, and multicystic dysplastic kidney, the detection rates of copy number variants (CNVs) by CMA and monogenic variants by WES were not significantly different (p>0.05). However, monogenic variants were more frequently detected than CNVs when kidney abnormalities were accompanied by reduced amniotic fluid (p<0.05). Other renal abnormalities identified on prenatal ultrasound had different detection rates. Our findings contribute to the overall knowledge of genetic variants associated with prenatally identified renal anomalies and may aid in decision making regarding prenatal genetic testing options for affected pregnancies.

MO110: Ultrasound Evaluation of Post-COVID Kidney Disease

Abstract BACKGROUND AND AIMS COVID can affect many organs including kidneys involving various possible pathophysiological mechanisms [1]. Post-COVID conditions require focused approach for diagnosis, personalized treatments and rehabilitation. Ultrasonography (US) can provide accurate information for detecting kidney disease [2]. Shear wave elastography (SWE) is a recognized ultrasound method, still having a limited use in nephrology, yet can be used for early detections of kidney abnormalities. The aim of this study was to evaluate semiotics and the added diagnostic value of US for post-COVID kidney disease. METHOD We included 20 cases to the study (23–68 years; 8 women) who underwent COVID-19 during last 3 months with signs of kidney disease (proteinuria, increased levels of creatinine, uric acid in blood, hypertension) and other clinical, laboratory symptoms of nephropathy after COVID-19 without specific data of previous history of kidney disease. The control group included 20 healthy individuals (9 women), with mean age 37 ± 7 years without clinical, laboratory signs of nephropathy according to disease history. All patients underwent general clinical, lab tests; abdominal US including precise multiparameter US of kidneys as in [2] measuring renal resistive index (RI), did SWE, and sensitive Doppler (B-flow and similar) in parenchyma and vessels using curved abdominal transducer of US systems: LOGIQ 9 (GE Healthcare), Toshiba Aplio and Hitachi Arietta. RESULTS We detected US changes in all age groups, both in females and males. Severe kidney disease signs included thinning, increasing echogenicity of kidney parenchyma (P &amp;lt; .05), detection of fibrotic changes and small hyperechoic inclusions, hilly margins, anaechoic strips under the capsule, RI increasing in segmental arteries over 0.75, and decreasing velocities under 25 cm/s. SWE showed increased parenchyma stiffness to 10 ± 1.7 kPa (6–13 kPa) versus 4.2 ± 1.2 kPa (P &amp;lt; .05). Moderate changes included mild decrease of kidney medullary differentiation, RI increasing in segmental arteries over 0.7; parenchyma stiffness increased to 7.2 ± 1.5 kPa (5–10 kPa), P &amp;lt; .05. In 16 patients we diagnosed hypertension; all patients had increased RI over 0.75; pyelonephritis was in 2 patients. Three patients had the following abnormalities: amyloid kidney after COVID-19 was in two patients (male 62 years and female 58 years) manifesting on US with increased echogenicity small kidney, decreased blood flow and increasing RI (Figure 1). One patient had collapsing glomerulopathy [3] manifesting with proteinuria; kidney biopsy with immunohistochemistry performed 1 month after beginning of COVID-19 showed collapsing focal segmental glomerulosclerosis; US symptoms were unspecific (Figure 2). CONCLUSION Multiparameter ultrasound is an effective method for early detection of various types of kidney disease in patients after coronavirus disease, potentially effective to distinguish signs of nephropathy associated to COVID-19. Evaluation of renal RI and increased stiffness of kidney parenchyma are reliable markers.

MO348: Methylene Blue Beneficial Effect in Treatment of Renal Calculi in Patient With Recurrent Urinary Tract Infection

Abstract BACKGROUND AND AIMS Assessment of efficacy of fixed combination of cranberry and sage extract with methylene blue (MBC) in dose of 30 mg twice daily in the prevention and management of chronic renal calculous disease. METHOD In 87 patients who complained recurrent urinary tract infection (UTI)—55 pts with pyelonephritis and 32 with cystitis—at least three episodes in 12 months, the impact of 3 months treatment of MBC with on renal calculi was investigated. All patients were older than 18 years without any biochemical or congenital kidney abnormalities, coagulopathies with size of renal stone over 10 mm. Simultaneous administration of phenothiazine derivatives, SSRI, MAO, tricyclic or any other antidepressants we excluded. A total of 39 (45%) of the patients with a history of nephrolithotomy in the past were included. RESULTS In most cases, patients were supervised during 12 months with 2–3 courses of MBC during the year. A total of 18 pts (21%) have passed no further stones with dramatic improvement of quality of life, and 47 (54%) have improved clinically with reduction of calculi size. A total of 79 pts (91%) reported overall clinical improvement of UTI symptoms and quality of life. The main disadvantage during MBC administration could be discoloration of the urine in light blue or green color. No side or adverse effects were observed during the whole period of the trial. CONCLUSION Methylene blue could be a promising solution in the management of patients with multiple small renal calculi, especially with necessity to reduce the level of concomitant infection without antibiotic and may be useful in the prevention of new stone formation.

8 SYSTOLIC BLOOD PRESSURE AS RISK FACTOR ASSOCIATED WITH PERSISTING PROTEINURIA AFTER DELIVERY IN WOMEN WITH PREECLAMPSIA

Background: Recent researches have established strong association between preeclampsia and end-stage renal disease (ESRD) in later life, however, the point where renal complications commonly begin after post-partum period is not clearly known. Early identification of abnormal kidney parameter in formerly preeclamptic women may potentially halt disease progression and prevent future irreversible damage. This study was conducted to evaluate factors associated with persistent renal endothelial damage reflected as proteinuria 3 months after delivery. Methods: This was a hospital-based matched case-control study conducted in Dr. Soetomo and Universitas Airlangga Hospital, Surabaya, Indonesia, between January to October 2021 involving 64 women with preeclampsia. The case-group included women with proteinuria 3 months post-partum (26 subjects) while control-group included those without proteinuria (38 subjects). Potential risk factors for persisting proteinuria were assessed through interview and medical record review. Odds ratio (OR) and their corresponding 95% confidence intervals (CI) were calculated. Results: Systolic blood pressure (SBP) obtained at diagnosis of preeclampsia was the only significant risk factor for persistent proteinuria 3 months after delivery found in this study (p=0.032). The women in the case and control group had a mean SBP of 168.27 ± 17.45 mmHg and 155.34 ± 13.86 mmHg respectively. From the Receiver Operating Characteristic (ROC) analysis, we discovered cut off point in 169 mmHg (OR 6.6; 95% CI = 1.96-22.24) with the value of area under the curves (AUC) 0.719. Conclusion: This study showed that elevated SBP is a significant risk factor for persisting proteinuria 3 months after delivery in preeclampsia patients. Recognizing this risk factor helps us in prioritizing patients who may benefit from tighter monitoring in post-partum period.

Hyperkalemia and Metabolic Acidosis Occur at a Higher eGFR in Sickle Cell Disease.

People with sickle cell disease (SCD) have an elevated estimated glomerular filtration rate (eGFR) compared with the general population, and this may alter the usual creatinine-based eGFR cutoffs for which physiologic evidence of kidney dysfunction is apparent. This study aimed to identify eGFR thresholds for hyperkalemia and metabolic acidosis in patients with SCD. This was a cross-sectional analysis of 733 patients with severe (hemoglobin SS or Sβ0-thalassemia) SCD genotype, 238 patients with moderate (hemoglobin SC or Sβ+-thalassemia) SCD genotype, and 1333 age- and sex-matched African Americans from the National Health and Nutrition Examination Survey (NHANES). The prevalence rates of hyperkalemia and metabolic acidosis were compared by eGFR category. Cutoffs for hyperkalemia and metabolic acidosis were determined using generalized additive models. Hyperkalemia and metabolic acidosis were more common in those with severe SCD genotype (13% and 21%, respectively) compared with the NHANES (0.3% and 5%, respectively); the prevalence rates in the moderate SCD genotype were intermediate for hyperkalemia (3%) and metabolic acidosis (11%). The proportion of patients with hyperkalemia and metabolic acidosis progressively increased with lower eGFR category in both SCD genotype groups. The eGFR thresholds for hyperkalemia and metabolic acidosis were higher in the severe (85 and 91 ml/min per 1.73 m2, respectively) and moderate (52 and 102 ml/min per 1.73 m2, respectively) SCD genotypes compared with the NHANES (34 and 46 ml/min per 1.73 m2). We demonstrate that hyperkalemia and metabolic acidosis are more common and occur at higher eGFR values in patients with SCD compared with age- and sex-matched African Americans, including in eGFR ranges considered to be normal. Future studies using redefined creatinine-based eGFR thresholds for abnormal kidney function may identify high-risk patients for earlier intervention strategies and referral for specialized renal care in SCD.

Analysis of Multiple Vitamins Serum Levels and Disease-Related Factors in Children with Acute Leukemia

Objective To explore the relationship between vitamins levels and disease-related indicators in children with acute leukemia (AL). Methods A total of 107 hospitalized children with AL were enrolled in this study and assigned to one group in each of the following categories: infected group (n = 52) and noninfected group (n = 55); treatment remission group (n = 56) and nonremission group (n = 51); high-risk (HR) group (n = 44), intermediate risk (IR) group (n = 53), and slight risk (SR) group (n = 8); cyclophosphamide + cytosine arabinoside+6-mercaptopurine + pegaspargase group (CAML, n = 15); methotrexate group (MTX, n = 9); and vindesine + daunomycin + L-asparaginasum + prednisone (VALP, n = 38). Hematological and serological parameters, hepatic and renal function, and changes in vitamins A, B1, B2, B6, B9, B12, C, D, and E serum content in children with AL were analyzed to investigate their relationship with AL disease-related factors. Results The vitamin D level was significantly higher in the noninfected group than in the infected group (P < 0.05). Compared with the nonremission group, the level of vitamin B1 in the treatment remission group was significantly higher, while the levels of vitamin B6 and B12 were notably lower (P < 0.05). The levels of vitamins B6 and B12 were notably different among the treatment groups. Multivariate analysis showed that hemoglobin (Hb) and C-reactive protein (CRP) were predisposing factors of AL in children. The disease type (acute lymphoblastic leukemia/acute myelogenous leukemia) was the factor affecting remission in AL children. Abnormal kidney function and the occurrence of icterus were the influencing factors for the risk degree in AL children. Platelet (PLT) count, activated partial thromboplastin time (APTT), neutrophils (N), and immunophenotype were shown to affect the choice of therapeutic regimens. Conclusion There are notable vitamins imbalances in children with AL. The imbalances influence disease-related factors and therefore provide some references for the prognosis and treatment of AL.

Outcomes After Lung or Combined Heart Lung Transplantation for PAH and CTEPH According to Baseline Kidney Function

<h3>Purpose</h3> Decreased renal function is often considered as a contraindication for lung (LTX) or combined heart-lung (HLTX) transplantation due to poorer prognosis and risk of further decline due to nephrotoxic medication. Severe pulmonary hypertension (PH) may decrease renal function because of low cardiac output and renal congestion, which may be reversible with transplantation. We aimed to assess whether pre-transplant kidney function is a predictor for mortality or need for renal replacement therapy (RRT) and evaluated the evolution of renal function after LTX or HLTX in PH patients. <h3>Methods</h3> We conducted a retrospective study in 68 consecutive patients diagnosed with PAH, chronic thromboembolic pulmonary hypertension (CTEPH) or PAH due to congenital heart disease who had undergone LTX or HLTX in our center between 1996 and 2019. 3 year survival according to pre-transplant kidney function was evaluated using the Kaplan-Meier method and by log-rank test. The evolution of eGFR according to pre-transplant kidney function was evaluated using mixed model effect test. Predictors of the need for RRT in the first 90 days and mortality after 1 year were identified by univariate analysis. <h3>Results</h3> 35 of 68 patients had an abnormal pre-transplant creatinine (cut off >1.15mg/dL for males, >0.95mg/dL for females). eGFR range was 38-121 ml/min/1.73m². 3 year survival was similar in both groups (67% versus 69%). In all patients, there was a trend to an improvement of kidney function at one month (eGFR +11.5 ml/min, P=0.055). At 6 months there was no longer a significant difference between the eGFR of both groups. A pre-transplant right atrial pressure of >15 mmHg was predictive for the need of RRT in the first 90 days, a baseline abnormal creatinine was not. The need for RRT in the first 90 days was predictive for mortality in the first year. <h3>Conclusion</h3> In patients with PAH, CTEPH or PAH related to congenital heart disease, a mild abnormal kidney function does not correlate with a higher risk of RRT or mortality after LTX or HLTX. eGFR may improve at one month suggesting an impairment due to hemodynamic status pre-transplant. At 6 months, there was no difference in eGFR according to the baseline kidney function. This suggests that pre-transplant kidney dysfunction is mostly determined by a hemodynamic factor and that it should only be considered as a relative contraindication for transplantation.

The effect of fetal hypoxia on myeloperoxidase levels in cord blood: a prospective study.

We aimed to compare myeloperoxidase (MPO) levels in cord blood samples of mothers with and without perinatal hypoxia, since fetal hypoxia results in decreased pH, base excess, and an increase in pCO<inf>2</inf> and lactate levels. We enrolled 42 pregnant women to this cross-sectional analytic study if they had met following criteria: uneventful gestational follow-ups, no known chronic or pregnancy-associated diseases, a BMI of <29.9, a singleton pregnancy, those with pregnancy over 34 weeks. The exclusion criteria for the study and control groups were as follows: presence of multiple pregnancies, fetal abnormality, any disease diagnosed before or during antenatal follow-up e.g., diabetes, hypertension, thyroid dysfunction, uncontrolled endocrine disease or abnormal kidney function, autoimmune disease, chronic inflammatory diseases, IUGR, preeclampsia), maternal age below 18 or above 35, intrauterine exitus, pregnancy with assisted reproductive technique, alcohol or smoking addiction, and any chronic drug use. The subjects were 1:1 randomized to either hypoxic newborns (N.=21) and those in the control group (N.=21) and their myeloperoxidase levels were measured from cord blood samples. Results were expressed as U/L. Patient data regarding age, gestation, parity, birth weight, birth length, APGAR scores, and neonatal complications were collected. All the women signed written informed consent forms and accepted verbal consent before being included in the study. The mean age of the study population was 26.9±5.3 years. The mean BMI was 28.3±3.5 kg/m2. For the hypoxic group, 21 newborns with cord blood below 7.25 were included in the study group. The bloods with pH above 7.25 formed the control group. Mean pH and five (5) minute APGAR scores were found to be significantly lower in the study group, while base excess (BE) was found to be significantly higher. In this study, we compared the MPO levels of hypoxic newborns and those in the control group, and we did not find a significant difference between the two groups (P=0.147). Pearson Correlation Analysis is at -0.566 with P value (0.008) showing significant negative correlation between MPO and pH in the study group. We found that MPO values are negatively correlated with cord blood pH among newborns diagnosed with fetal hypoxia.

IDENTIFIKASI HASIL MAKROSKOPIS DAN MIKROSKOPIS URIN PADA PASIEN TUBERKULOSIS

Tuberculosis (TB) is an infectious disease directly transmitted through the air. This disease is caused by the bacterium Mycobacterium tuberculosis. Tuberculosis requires an incubation period of 3-6 months from initial exposure to the bacteria. Patients identified with tuberculosis will be given anti-tuberculosis drugs intensively for 6 months. Long treatment time resulting in drug accumulation can affect the kidneys. Microscopic examination or urine sediment aims to detect kidney and urinary tract abnormalities and monitor the results of treatment. This study used an experimental research type, then the primary data were analyzed descriptively. Identification of the results of macroscopic and microscopic urine in tuberculosis patients in the hospital. Lungs Surabaya, showed the largest percentage of 75% macroscopic results of clear yellow urine. Microscopic results showed normal values compared to normal macroscopic and microscopic ranges of urine.Keywords :Tuberkulosis, Mikroskopis Urin, Makroskopis Urin

Challenging retrograde intrarenal surgery in a pelvic ectopic kidney- an institutional case report and review of literature

Retrograde intrarenal surgery (RIRS) has been increasingly used as an effective treatment modality for treatment of stones in anatomically abnormal kidneys. A challenging RIRS in a 27-year-old man, done for a 1 cm calculus in a pelvic ectopic kidney is being presented here in order to highlight the technical difficulties encountered, safety and outcome of RIRS for pelvic ectopic kidneys. A 27-year-old man presented with the chief complaints of left sided flank pain of one year duration. He was discovered to have a left pelvic ectopic kidney 7 years back and later discovered to have a calculus within it 1 year back. He had a history of an attempted rigid ureteroscopy 2 months back at another hospital where they were unable to reach the stone, so they placed a Double J stent over a guidewire. The patient was worked up and taken up for surgery at our institution. Intraoperatively there was a kink at the PUJ, below which the access sheath was placed under C arm guidance and with the flexiscope, the kink was negotiated to reach the stone. Holmium laser was used to disintegrate the stone and DJ stent was placed. Post operatively patient was stable and discharged on day 2. RIRS is a safe and effective modality for the treatment of calculi in pelvic kidneys as seen, technical difficulties like kinks can be overcome by flexiscopy.