Albumin Creatinine Research Articles

Albumin creatinine index added to the grace score increases its discriminative capacity for mortality at 12 years of follow-up in patients with acute coronary syndrome

Abstract introduction There is currently no information on the prognostic value of the GRACE score with the additional addition of the albumin-creatinine index (ABI) for the prediction of very long-term mortality in unselected populations of acute coronary syndromes (ACS). Objectives To evaluate the additive value of the albumin-creatinine index in spontaneous urine sample to the GRACE score for the prediction of 12-year mortality from all causes in an unselected cohort of patients with acute coronary syndrome. Material and methods A prospective cohort study was carried out, which included patients admitted to a Community Hospital with a diagnosis of ACS. These patients had their IAC measured in a single spontaneous urine sample based on the principle of immunoturbidimetry in the first 24 hours of admission. The end point of the analysis was all-cause mortality at follow-up. The GRACE 2.0 score was calculated for all patients in the study. The scores were compared according to the following metrics: their power to discriminate between events and non-events (ROC Areas), calibration or goodness of fit, evaluating the agreement between the proportion of events and non-events expected by both scores observed by Hosmer Lemeshow Test. The comparison between the areas under the ROC Curves was carried out using De Long's test with the MEDCALC program version 19.1.7. The net reclassification index and its 95% CI (GRACE score + IAC/GRACE score) were evaluated. Results 600 patients with ACS were analyzed, with an average age of 64 years. The GRACE score risk subgroups were divided by the established cut-off values: low risk (0 to 108), intermediate (109 to 139) and high risk (greater than 139). The area under the curve of the Grace score for mortality during follow-up was 0.79 (95% CI 0.69-0.89), while the area under the ROC curve of the GRACE + IAC score was 0.81 (95% CI 0.74-0.87). ). Comparing the two areas by the De Long test, the difference was statistically significant (P < 0.0001; 95% CI 0.07- 0.015). On the other hand, contingency tables were developed and the Hosmer Lemeshow Test (goodness of fit) was performed on the GRACE score and the GRACE + IAC score, observing agreement between expected events and non-events, throughout all subgroups of risk. In addition, reclassifications were made into deceased and survivors by applying the GRACE + IAC score on the GRACE score. The net reclassification rate was 28% (95% CI 21-35). The chi square of its Mc Nemar Test was 3.69 p < 0.0002. The absolute comprehensive discriminatory improvement was 0.01 (95% CI 0.009-0.02) and the corresponding relative value was 8.2% (95% CI 7.9-8.5). Conclusions In this unselected ACS cohort, the albumin-creatinine index added to the GRACE score significantly increases its ability to discriminate mortality from all causes in a 12-year follow-up.Comparison between ROC curvesHosmer Lemeshow test

THE PRONOSTIC VALUE OF NOCTURNAL BLOOD PRESSURE IN UNTREATED ADULT HYPERTENSIVES FROM ALGERIAN POPULATION

Objective: The aim of our work is to study the prevalence of nocturnal blood pressure patterns in our Algerian population of untreated adult hypertensives and its impact on target organ damages. Design and method: We recruited 304 untreated adult hypertensives. All our patients underwent 24-hour ABPM, and the following target organe damages assessment: ACR (urinary albumin/creatinine), echocardiography, fundoscopy, and carotid ultrasound. Our patients were classified according to nocturnal blood pressure into two groups: nocturnal hypertensive (NH: BP> or = 120/70) and nocturnal normotensive (NN: BP<120/70). We carried a descriptive study of hypertension prototypes, followed by an analytic study in search of predictors of target organ damages (cardiac, renal and vascular). Results: The mean age was 46±12 years, with 82% males. The prevalence of patterns according to nocturnal blood pressure were: NH (n=250; 82.2%) vs NN (n=54; 17.3%). In the bivariate analysis, there was a significant difference between two groups for the following damages: cardiac (HN=52% vs NN=34.6; P=0.01), renal (HN=27.5% vs NN=12.8%; P=0.02) and vascular (HN=25% vs NN=2%; P<0.001). On multivariate analysis, indexed LV mass was correlated with waist circumference (B=0.34, P=0.01) and diurnal systolic BP (SBP) (B=1.37; P<0.001). ACR was correlated with glycemia (B=0.33; P=0.002) and nocturnal SBP (B=0.64; P=0.01). Intima-media thickness was correlated with age (B=0.009, P<0.001) and nocturnal SBP (B=0.004, P<0.001). On logistic regression, cardiac damage was correlated with age (OR=1.05; P=0.02), BMI (OR=1.21; P=0.02) and diurnal SBP (OR=1.08; P=0.003). Renal damage was correlated with glycated hemoglobin (OR=1.6; P=0.04). Vascular damage was correlated with age (OR=1.3; P<0.001) and nocturnal diastolic BP (DBP) (OR=1.07; P=0.002). Conclusions: The nocturnal hypertension are prevalent in our population. nocturnal hypertension is a predictor of renal and vascular damages. In contrast, diurnal hypertension is a predictor of cardiac damage. These results confirm the literature data on the prognostic value of nocturnal blood pressure. We suggest an active screening for nocturnal hypertension by using ABPM in the hypertensive population with high cardiovascular risk.

Comparison of Serum Chromogranin-A with Albumin-Creatinine Ratio among different groups of Type-2 Diabetics

Background: Diabetic nephropathy is a common complication of diabetes mellitus that cause high morbidity & mortality. Aim: To compare levels of serum chromogranin-A among different groups of type-2 diabetes mellitus patients based on urinary Albumin-Creatinine Ratio. Study design: Cross sectional comparative. Methodology: Present study was conducted at Chemical Pathology Department of General Hospital-Lahore. Patients (n=116) were enrolled through probability convenient sampling. Urine samples were centrifuged to obtain clear supernatant. In this separated supernatant urinary albumin and creatinine was measured. Blood samples were segregated according to the study groups (A, B, C and D). Serum was separated for analysis of serum creatinine and serum chromogranin A by ELIZA method. Data was evaluated by using SPSS v.24. ANOVA was used to compare mean levels of urinary ACR AND serum CgA among the groups with P-value of 0.05 was considered as significant. Results: The results showed that serum Chromogranin-A level was high in diabetic patients with normal ACR and kept on rising with increasing ACR. Data of age was normally distributed whereas, the distribution of albumin creatinine ratio and serum chromogranin-A was not normal. Conclusion: It was concluded that serum Chromogranin A can be used as early marker for the diagnosis of diabetic nephro-pathy thus can help in better management of nephropathy due to diabetes. Keywords: Diabetic Nephropathy, Albumin-Creatinine Ratio, Serum Chromogranin-A and Type-2 Diabetes.

RASIO ALBUMIN KREATININ URIN SEBAGAI DETEKSI DINI GANGGUAN FUNGSI GINJAL PADA DIABETES MELITUS

Diabetes Mellitus is a group of metabolic diseases of impaired glucose intolerance that is closely related to renal vascular breast milk degener abnormalities that begin with the presence of microalbuminuria. Increased serum creatinine levels indicate impaired kidney function. Serum microalbuminuria and creatininelevels are important tocheck because they are indicators of the course of diabetes mellitus. The goal of this study was to examine the ratio of albumin-creatinine urine in people with diabetes mellitus can be used as an early detection of impaired kidney function and see an association between the ratio of urinary creatin albumin and serum creatinine levels. The urine albumin examination method uses immunoturbidimetric assay using the Jaffe method. The subjects of the examination were dm sufferers who conducted fasting blood glucose and HbA1c examinations at Pramita Clinic Laboratory Surabaya. From the results of the study obtained the ratio of albumin creatin urine and serum creatinine in people with DM mostly showed an increase in the ratio of urinary creatin creatin of 117.10 mg / g, while the average results of serum creatinine examination are still within the normal limit, which is 1.0 mg / dl. From this study proves that examination of the ratio of creatin creatin urine can be used as an early detection of kidney function disorders. Keywords: diabetes mellitus, microalbumin urine, serum creatinine

Haemato-biochemical studies in medically managed open and closed-cervix pyometra in dogs

Six dogs each with open and closed-cervix pyometra (Group I and II) were medically managed with mifepristone @ 2.5mg/kg body weight orally twice daily for five days, followed by cloprostenol @ 5?g/kg body weight subcutaneously on every alternate day after ensuring cervical patency, till complete evacuation of uterus was assessed by ultrasonography. Haematological and serum biochemical values were estimated on the day of presentation. The treatment response was assessed by reviewing both haematological and serum biochemical values further on days 3, 7, 14 and 21 of treatment. The mean total erythrocyte count (TEC), haemoglobin concentration and volume of packed red cells (VPRC) were significantly lower and mean total leucocyte count (TLC) was significantly higher in all animals of both groups during the day of presentation. The values significantly improved after initiation of treatment. Total thrombocyte count, serum total protein, albumin, BUN and serum creatinine levels were within the normal range. TEC, TLC, Hb concentration, VPRC could be used for prognostic markers of treatment evaluation in canine pyometra.

Remission after Six Months of Induction Immunosuppressive Treatment with Mycofenolate Mofetil and Prednisolone in Patients with Lupus Nephritis: A Descriptive Cross-sectional Study.

Treatment of lupus nephritis consists of six months of induction immunosuppression followed by years of maintenance immunosuppression. The aim of present study was to find the prevalence of remission after six months of induction immunosuppressive treatment with induction therapy in patients with lupus nephritis. A descriptive cross-sectional study was conducted in the nephrology unit of department of internal medicine of a tertiary care hospital from September 2018 to September 2020. The study was approved by institutional review committee of same institution (reference number 184/2018). Convenience sampling method was used and Statistical Package for Social Sciences version 26 was used for statistical analysis. Point estimate at 90% Confidence Interval was calculated along with frequency and proportion for binary data. Out of 24 patients, overall remission was seen in 21 patients (87.4%) (90% Confidence Interval= 76.26-98.54). Complete remission and partial remission were seen in 16 (66.6%) and 5 (20.8%) patients respectively resulting in an at the end of six months of induction immunosuppressive treatment. The most common class of lupus nephritis was class IV, 7 patients, followed by class IV+V, and class V, 6 patients in each respectively. The mean 24-hour urinary total protein, serum albumin and serum creatinine were 2492±1051 mg, 2.1±0.4 g/dl, and 0.9±0.1 mg/dl respectively. Adverse events were observed in 6 (25%) patients. Our study shows that good proportions of patients with lupus nephritis achieve clinical remission at the end of six months of induction immunosuppressive treatment with induction therapy, however, at the cost of some tolerable side effects.

Clinical efficacy and safety of different tacrolimus concentrations for the treatment of patients with idiopathic membranous nephropathy

This retrospective study aimed to explore the relative efficacy and safety of different tacrolimus (TAC) concentrations in the treatment of patients with idiopathic membranous nephropathy (IMN). A total of 260 IMN patients with nephrotic syndrome (NS) were recruited. Among these, 125 patients had TAC concentrations no greater than 5 ng/ml (CTAC ≤ 5 ng/ml), and 135 patients had TAC concentrations greater than 5 ng/ml (CTAC > 5 ng/ml). The primary outcomes included complete remission (CR) rates and overall (OR) response rates. The secondary outcomes included 24-h urinary protein (24-h UP), serum albumin and serum creatinine, and adverse events (AEs). During the 12-month follow-up, the overall response rates were significantly different between the CTAC ≤ 5 ng/ml group and the CTAC > 5 ng/ml group (P < 0.0001). However, there was no significant difference in the CR at 12 months between the two groups (chi-square, 62% vs 63%, P = 0.852). Compared with the CTAC ≤ 5 ng/ml group, the CTAC > 5 ng/ml group had improved levels of 24 h UP (P = 0.017) and serum albumin (P = 0.010). Moreover, the incidences of acute reversible nephrotoxicity (P < 0.001), hepatotoxicity (P = 0.036), new-onset diabetes mellitus (P = 0.036), and glucose intolerance (P = 0.005) were lower in the CTAC ≤ 5 ng/ml group than in the CTAC > 5 ng/ml group. The CTAC > 5 ng/ml group was improved relative to the CTAC ≤ 5 ng/ml group in terms of a PR and CR at 6 months, but there was no difference in the CR between the two groups at 12 months.

Aflatoxicosis in Pekin duckling and the effects of treatments with lycopene and silymarin.

Background and Aim:Aflatoxins (AFs) are potent toxic metabolites produced from Aspergillus species. Whose existence in poultry ration leads to drastic economic losses, notably in duck, as the most susceptible poultry species. This study aimed to determine tissue residues of AFs, alterations in selected clinical chemistry variables in serum, mainly during the exposure period, and lycopene and silymarin’s possible roles as herbal treatments against aflatoxicosis in Pekin duckling.Materials and Methods:The study used one hundred and twenty one-day-old Pekin ducklings and classified them into four groups comprising 30 ducklings in each group. The control group (G1) ducklings were fed a mycotoxin-free ration, and G2 received a naturally contaminated ration with 30 ppb of AFs. G3 and G4 consumed contaminated rations with AFs with 30 ppb for 2 weeks and were treated with lycopene 100 mg/kg or silymarin 600 mg/kg/food, respectively, for 10 days. Serum activities of alanine transaminase and alkaline phosphatase (ALP), glutamyl transferase, ALP, total protein and albumin creatinine and uric acid concentrations, oxidant/antioxidant parameters (malondialdehyde [MDA], total antioxidant capacity (TAC), glutathione S-transferase (GST), and catalase [CAT]), and hepatic AFs residue were determined. Lycopene and silymarin were used for the treatment of aflatoxicosis for another 10 days.Results:Hepatic and kidney parameters were elevated in the AFs intoxicated group and reduced in the lycopene- and silymarin-treated groups. They had elevated MDA and AFs residues with decreased antioxidant parameters (TAC, GST, and CAT) in the AFs group. At the same time, treatment with lycopene or silymarin had reversed the action of AFs on MDA, elevated the hepatic residue, and improved antioxidant activity.Conclusion:Lycopene and silymarin, with their potent antioxidant activity, can be used to reverse the harmful effects of AFs on hepatic and kidney tissue.

Sociodemographic and clinical predictors of refractory type 2 diabetes patients: Findings from a case-control study.

Objectives:To identify the sociodemographic and clinical predictors of uncontrolled diabetic patients, to identify high-risk and people with impaired glycemic control, to establish more effective strategies for reducing morbidity and mortality.Methods:This case-control study of 8209 enrolled patients were included from the diabetes registry by Chronic Illness Center (CIC), Family and Community Medicin, Prince Sultan Military Medical City, Riyadh Saudi Arabia between February 2019 and February 2020. Cases are defined as patients with type II refractory diabetes having persistent HbA1c >9, not reach adequate glycemic control despite intensified therapy under specialist care (CIC) for at least 6 months. Controls were defined as patients with Hba1c ≤9. Multivariable regression analysis was used to identify predictors for patients with the persistent outcome of HbA1c >9%.Results:Overall, a total of 1152 cases and 4555 controls were included. Patients with refractory diabetes were younger (mean: 58.5, standard deviation [SD]: 11.7) and females (63.4%). Duration of diabetes (13.3, SD: 7.4, p<0.001) and the mean value of low-density lipoprotein (LDL) (2.7, SD: 0.91, p<0.001) were significantly higher in the refractory group. The findings from the final model revealed that with every unit increase in age (odds ratio [OR]: 0.97, [95% confidence interval [CI]: 0.96-0.98]) and body mass index the odds of having refractory diabetes significantly reduced by 0.97 times (OR: 0.97, [95% CI: 0.95-0.99]). While with every unit increase in the duration of diabetes (OR: 1.03, [95% CI: 1.01-1.05]), systolic blood pressure (OR: 1.01, [95% CI: 1.00-1.02]) and LDL (OR: 1.42, [95% CI: 1.23-.62]) the odds of having refractory diabetes significantly increased by 1.03 and 1.42 times respectively compared to controls when adjusted for gender, albumin creatinine, diastolic blood pressure.Conclusion:The findings from this study helped classify the predictors of refractory patients with diabetes. Understanding refractory patients’ predictors may help to develop new therapeutic strategies to boost their glycemic status safely.

A prospective study to evaluate accuracy of urine albumin-creatinine ratio in diagnosis of pre-eclampsia; A single centre observational study

The aim of this paper is to diagnose pre-eclampsia with spot urine albumin-creatinine ratio (ACR). Our study comprised of one hundred ten pregnancies within 20-28 weeks of gestation. Spot mid- stream urine sample was collected from all pregnant females and urine ACR estimation was done using immunoturbidimetric microalbumin method and modified Jaffe’s method for creatinine estimation. We found sensitivity of 90.4%, specificity of 98%, PPV of 91.6% and NPV of 97.2%. Systolic blood pressure in unaffected subjects was 110.2 mm Hg and in pre- eclamplsia was 152.6 mm Hg. Diastolic blood pressure in unaffected subjects was 78.4 mm Hg and in pre- eclamplsia was 96.8 mm Hg. In unaffected subjects, 4.5% showed positive test and 95.5% showed negative test. In pre- eclampsia subjects, 87.2% showed positive test and 12.8% showed negative test. Mann Whitney U test showed significant difference between two (Significant, P&lt; 0.05). It has been observed that the role of urine albumin creatinine ratio in detection of Pre-eclampsia is evident. A higher sensitivity and specificity revealed its usefulness in early detection.

Interlaboratory bias of albuminuria and proteinuria in hypertensive pregnancy

BackgroundMeasurement of proteinuria in women with hypertensive disorders of pregnancy is of major importance in the diagnosis and management of preeclampsia. Urinary protein/creatinine ratio, which is commonly used to detect kidney damage in preeclampsia, suffers from important analytical limitations, including poor harmonization of results between laboratories. Adoption of albuminuria could help reduce interlaboratory bias, since methods used to quantify it are better harmonized. MethodsA total of 27 urinary samples collected from hypertensive women evaluated for preeclampsia were sent to four different clinical laboratories in Canada. Urinary proteins and albumin as well as urinary creatinine were measured in duplicates in one batch to calculate protein/creatinine (PCR) and albumin/creatinine (ACR) ratio. Statistical analyses were done to evaluate interlaboratory variability of urinary proteins and urinary albumin. ResultsInterlaboratory bias for urinary proteins ranged from 64.7% at low concentration to 3.9% at higher concentrations. In contrast, urinary albumin interlaboratory bias ranged from 29.2% to 4% from low to high concentrations. Coefficient of variation for urinary proteins reached a maximum of 91.5% in lower concentration while urinary albumin highest value was 42.7%. When looking at PCR and ACR ratio, eight samples had PCR measurement range that contained the diagnostic threshold used to detect kidney damage in HDP (30 mg/mmol), while only four samples had ACR ratio measurement range that contained the diagnostic threshold used outside of pregnancy in Canada (2 mg/mmol). ConclusionInterlaboratory bias was lower for urinary albumin measurement compared to urinary proteins in hypertensive women evaluated for preeclampsia. Better harmonization with the use of albumin instead of protein measurement would reduce instances where results of different laboratories lead to opposite diagnosis of kidney damage in pregnancy.

A comparative study of efficacy of enalapril versus telmisartan in patients with diabetic nephropathy

Background: Diabetic nephropathy (DN) is the leading cause of end-stage renal disease (ESRD) worldwide and is estimated that ~20% of type 2 diabetics develop ESRD during their lifetime. In type 2 diabetics with microalbuminuria, both enalapril and telmisartan have shown to reduce microalbuminuria, thereby delaying the progression of renal disease in diabetics. Aim and Objective: This study aims to evaluate the efficacy of enalapril versus telmisartan among patients with DN for 6 months. Materials and Methods: A prospective, open-labeled, randomized, comparative study was conducted involving 100 type 2 diabetics with mild hypertension and Grade I DN was divided randomly into two groups of 50 each, aged between 18 and 69 years with either sex, attending medicine outpatient department or admitted in medicine wards. One group received tab. enalapril maleate, 5–10 mg/day, while other group received tab. telmisartan, 40–80 mg/day, and were followed up once a month for 6 months. Efficacy was assessed using urine albumin, serum urea, serum creatinine, and blood pressure (BP). Results: Demographic and baseline urine albumin level, serum urea, serum creatinine, and BP were comparable between two groups. Early improvement in urine albumin and serum creatinine levels was seen with enalapril (at 2 months, urine albumin: P = 0; at 3 months, serum creatinine: P = 0.007). Reduction of BP was greater with telmisartan (systolic BP/diastolic BP (DBP): P < 0.001). In later phase, no significant difference was observed between two groups among the parameters such as urine albumin estimation (P = 1) and serum urea (P = 0.286). Conclusion: Both enalapril and telmisartan were equally efficacious in DN. However, enalapril had better response than telmisartan in our study.

Evaluation of the Association between Ischemia Modified Albumin (IMA), Glycemic and Lipid Status in Diabetic Nephropathy

Introduction: Hyperglycemia induced oxidative stress in Type 2 Diabetes Mellitus modify various biomolecules to cause Diabetic Nephropathy (DN). IMA (Ischemia-Modified Albumin) is one such oxidative stress marker already examined in various clinical events but have not yet been evaluated in different stages of DN.&#x0D; Aim: To estimate and assess the relationship of IMA with glycemic status and lipid parameters in all stages of DN.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Study was conducted at Department of Biochemistry, Kasturba Medical College Hospitals, Mangaluru conducted between 2014 and 2015.&#x0D; Materials and Methods: There were 60 type 2 diabetic cases and 30 healthy controls. Diabetic cases were further categorized into three equal groups on the basis of UACR (urine albumin-creatinine ratio), DN stage I having UACR less than 30 mg/g, DN stage II having UACR 30 to 300 mg/g, and DN stage III having UACR ≥ 300 mg/g of creatinine. Using enzyme-linked immunosorbent assay serum IMA level was estimated whereas automated analyzers was used for serum creatinine, HbA1c, urine albumin and urine creatinine analysis.&#x0D; Results: Lowest level of IMA (109 ng/mL) measured in DN stage I, which was significantly different from those in DN stage II (154 ng/mL) and DN stage III (178 ng/mL). The significant positive correlation between IMA and fasting blood glucose, glycated hemoglobin were present in stage II and stage III DN. In this study significant positive correlation of serum IMA to serum total cholesterol, low density lipoprotein cholesterol and negative correlation with high density lipoprotein were revealed in all stage of DN.&#x0D; Conclusion: Current study postulates that early evaluation of serum IMA in diabetic patients with deranged lipid profile will provide an index of nephropathy development. This will help in prognosis and controlling complication in diabetes mellitus.

Jadenu Substituting Exjade in Beta Thalassemia Major (BTM) Patients with Iron Overload: Effect on Serum Ferritin Concentration, Liver Iron Content and Biochemical Profiles

Thalassemia major (TM) requires chronic blood transfusions ultimately cause iron overload and subsequently end-organ damage unless corrected. Iron chelation has been proven to decrease organ dysfunction and improve survival in transfusion-dependent β-thalassemia. However, taking iron chelation therapy every day has sometimes been a challenge in patients. Deferasirox is a once-daily, oral iron chelator that developed out of a need for a long-acting chelator. The approved mode of administration requires taking deferasirox on an empty stomach with water, apple juice, or orange juice to limit variation in bioavailability. This required administration schedule might not be palatable for patients. Additionally, approximately one-quarter of patients experience mild to moderate gastrointestinal symptoms, which may pose additional challenges.Jadenu is a new oral formulation of Exjade tablets for oral suspension. While Exjade is a dispersible tablet that must be mixed in liquid and taken on an empty stomach ,Jadnu can be taken in a single step, with or without a light meal, simplifying administration of treatment and allows greater convenience and may be associated with fewer gastrointestinal side effects versus the original formulation. This may significantly improve compliance. In addition, the new formulation may be associated increased bioavailability.Jadenu is 36% more bioavailable than the original formulation, Exjade®. Therefore, to convert from Exjade to Jadenu the dose of Jadenu should be about 30% lower, rounded to the nearest whole tablet. To date, the new formulation of deferasirox has only been evaluated in pharmacokinetic studies in healthy volunteers. No clinical data are available yet in patients taking this formulation.The objective of this study was to compare the effect of Jadenu substituting Exjade on serum Ferritin concentration, liver iron content and biochemical profile in (BTM) patients with iron overload.Patients and Methods:Twelve adult patients with BTM were studied. All patients were on regular packed cell transfusion therapy monthly to keep their Hb not less than 9 g/dl before transfusion. They were on Exjade therapy (30 mg/kg per day) for 5 years or more before changing them to Jadenu therapy (14-28mg/kg/day).We evaluated Serum ferritin and the liver iron (LIC) measured by the Ferriscan method. Investigations included measuring hepatic functions (alanine transferase (ALT), aspartate transferase (AST), alkaline phosphatase (ALP) and albumin) , creatinine and fasting blood glucose (FBG) every clinic visit (q 3 months). In addition thyroid function (free T4 (FT4), thyrotropin (TSH), 25 OH vitamin D and PTH levels were measured before and one year after starting Jadenu therapy. Patients were monitored for gastrointestinal and other reported side-effects related to the drugs. All patients were on vitamin D 800 U/day and folic acid 5 mg / day.Paired t student test was used to compare lab results before versus after Jadenu treatment. Linear regression equation was used to investigate possible relation between variables.ResultsA year after treating patients with Jadenu serum ALT decreased (non-significant) but there was no significant change in circulating concentrations of creatinine, albumin, ALP or FBG. (Table 1) Apart from some gastrointestinal complaints reported in 3 patients that did not require discontinuation of therapy, patients did not have any other side effects.There was a non-significant decrease in LIC and ferritin levels after 1 year of using Jadenu. Thyroid and parathyroid hormone did not change during Jadenu therapy. (Table 2)A positive significant correlation was found between serum ferritin level and LIC measured by ferriscan method. LIC and serum ferritin level were correlated significantly with ALT level ( r = 0.31 and 0.45 respectively, p < 0.05) . No significant correlation was detected between LIC and other biochemical or hormonal levels.This study showed that the use of Jadenu after Exjade was associated with non-significant decrease in liver iron and ALT. There was no change in FBG, creatinine albumin or thyroid function. No side effects required discontinuation of the medicine.Conclusion:Jadenu is more palatable and improve quality of life for patients with BTM, however it was associated with minimal decrease in LIC and ALT level suggesting marginal improvement of iron chelation probably due to easier administration. DisclosuresNo relevant conflicts of interest to declare.

Albumin-Creatinine Ratio is More Diagnostic Sensitive than Cystatin-C in Assessment of Diabetic Peripheral Neuropathy

Background: Diabetic Peripheral neuropathy is one of the most common cardiovascular complications among diabetes mellitus patients and occurs in more than half of the population of diabetic patients world-wide. It is a common cause of foot ulcer, gangrene and amputation among diabetics. Thus, its prevention or early treatment can improve the quality of life of diabetic patients. In a bid to reduce it, various biochemical markers have been evaluated to enable early treatment and amelioration of diabetic neuropathy among diabetes mellitus patients. Aim: Evaluation of the diagnostic relevance of Cystatin-C versus Albumin-creatinine ratio in assessment of Peripheral neuropathy in diabetic type 2 subjects. Method: 102 type 2 DM subjects (66 females and 36 males) and 100 control subjects of same age range (40 – 80 years) were recruited for this study which includes 51 subjects with peripheral neuropathy and 51 subjects without peripheral neuropathy. Serum Cystatin-C, Microalbuminuria, Urine creatinine and HBA1c were analysed with standard methods. Results: Cystatin-C, Microalbuminuria, Albumin-creatinine ratio and Glycated haemoglobin were significantly elevated (P&lt;0.05) in diabetic subjects compared to the control. Cystatin-C (ng/ml), microalbuminuria (mg/l), albumin creatinine ratio (mg/mmol) and HBA1c (%) is [105.52 ± 45.11; 90.07±20.29; 10.48 ± 4.82; 6.9±1.7] respectively. Microalbuminuria, albumin creatinine ratio showed significant increase (P&lt;0.05) in subjects with peripheral neuropathy compared to those subjects without [92.11± 22.82; 35.70±16.35; 2.61±1.1; 6.38±1.79]. The ROC curve shows that Albumin-creatinine ratio showed significant (P&lt;0.05) sensitivity to peripheral neuropathy [AUC=0.714] while Cystatin-C showed no significant (P&lt;0.05) sensitivity to peripheral neuropathy complication [AUC=0.553]. Conclusion: Cystatin-C was found to be deranged in diabetics. However, Albumin-creatinine ratio showed more diagnostic sensitivity for peripheral neuropathy than Cystatin-C.

Membranous nephropathy with light chain restricted deposits

The literature on membranous nephropathy (MN) with monoclonal deposits on immunofluorescence (IF) and their outcome is very scarce. We report our experience of managing five patients with this clinical entity. The mean age of the patients was 33.2 ± 6.55 years. The mean proteinuria, serum albumin and serum creatinine was 5.73 ± 2.17 g/day, 2.86 ± 0.51 g/dL and 1.34 ± 1.19 mg/dL, respectively. None of the patients had a lymphoproliferative disorder. Only one patient had an elevated free light chain ratio. Four (80%) patients were M-type phospholipase A2 receptor (PLA2R) negative (tissue and serum), and one (20%) was PLA2R related. Three (60%) cases had monoclonal IgG3/k, one IgG3/λ, whereas one patient with PLA2R positivity had an IgG3/IgG4k subtype. Two (67%) patients treated with cyclical cyclophosphamide and steroids (cCYC/GC) achieved complete remission and one patient (33%) with elevated baseline creatinine had a reduction in serum creatinine with persistent proteinuria at the end of the 12th month of follow-up. One patient with PLA2R positive MN was treated with Rituximab and is in complete remission. The patient with an elevated free light chain at baseline was treated with Bortezomib/Thalidomide/Dexamethasone, had complete remission at 12 months, however, had a progressive rise in creatinine over the next 40 months of follow-up. The current series, though limited by numbers, documents the efficacy of conventional therapies in non-malignant associated MN with monoclonal deposits on IF.

Agreement between the ‘point of care’ tests for microalbuminuria and HbA1c performed in mexican family medicine units and the results of standard laboratory tests

The albumin-creatinine ratio is considered an indicator of microalbuminuria, precursor to chronic kidney disease, while HbA1c is used to measure glycemic control. Given the prevalence of diabetes-related nephropathy, spot testing of albumin has long been recommended as a preventative measure, for the timely detection of microalbuminuria. However, many countries do not have this testing available in primary care, and sometimes not even in second- and third-level care. The objective of this study was to compare agreement of the microalbuminuria and HbA1c results obtained in the laboratory with ‘gold standard’ techniques, with those obtained on site with a ‘Point of Care’ DCA Vantage™ device by Siemens. Results for the albumin–creatinine ratio and HbA1c from the Siemens DCA Vantage™ point of care device were compared with those from standard laboratory tests in 25 family medicine units in Mexico City and Toluca, State of Mexico, in patients diagnosed with type-2 diabetes. Agreement between the albumin values of the 2 tests was 0.745 (CI 95% 0.655–0.812). Agreement between the two measurement techniques for HbA1c was 0.970 (CI 95% 0.966–0.973). The results obtained were sufficiently comparative (Ri= 0.74 for albumin-creatinine ratio and Ri = 0.97 for HbA1c) to justify the use of the point of care device. Given the high agreement between the point of care device and laboratory tests, this device could be used to identify chronic kidney disease and glycemic control for more adequate treatment in patients with diabetes, especially in remote areas.

Pulmonary edema in preeclampsia: an Indonesian case–control study

Objective: To analyze risk factors, obstetric outcome and the need for mechanical ventilation in preeclampsia complicated by pulmonary edema.Materials and methods: Case–control study using medical record on preeclampsia complicated by pulmonary edema patients in East Java tertiary referral hospital over 2 years. A simple scoring system was developed to predict the need for mechanical ventilation, using logistic regression.Results: 1106 cases of preeclampsia were admitted, with 62 cases (5.6%) had pulmonary edema. Postpartum (p < .001) and cesarean delivery (p = .001) proportions were higher in the preeclampsia with pulmonary edema group. Of the 62 cases with pulmonary edema, 81% required intensive care admission and 60% needed mechanical ventilation support. Mechanical ventilation used was associated with eclampsia (p = .04), hypertensive crisis (p = .02), lower serum albumin (p = .05) and higher creatinine (p = .01). A simple scoring model developed could predict a 46%–99% probability of need for mechanical ventilation (AUC (ROC): 0.856, 95%CI 0.763–0.95).Conclusions: Pulmonary edema is a common complication of preeclampsia in Indonesian referral hospitals. This severe complication increased maternal and perinatal morbidity and mortality. The developed scoring model in this study can be used as a triage tool to predict the probability of mechanical ventilation use due to this complication.

Prevalence of diabetes mellitus and impaired fasting glucose among hypothyroid patients

Background: The association between autoimmune thyroid diseases and autoimmune diabetes is well established. However, the association between type 2 Diabetes and thyroid disease is unclear. Studies conducted on this topic worldwide have revealed varying results. The aims of this study were to assess the prevalence of diabetes and impaired fasting glucose in a group of hypothyroid patients in Sri Lanka and to assess the relationship between severity and etiology of hypothyroidism with diabetes and impaired fasting glucose. Method: This descriptive (prospective) study was conducted at the Endocrine clinic, Teaching Hospital, Ragama over a period of 12 months, where all the new and follow up patients with hypothyroidism (both overt and subclinical hypothyroid patients) attending the clinic during this study period were included until the sample size is achieved. Interviewer-administered questionnaire was used to obtain relevant data from the patient and from the clinic book. Fasting blood sugar was done for all patients. When FBS ≥ 100mg/dl, the test was repeated. For patients who had repeatedly elevated FBS ≥ 100mg/dl, Urine for micro albumin and serum creatinine were also checked. If the urine micro albumin was elevated, the test was repeated after 3 months. The presence of retinopathy was assessed by the ophthalmology team. Results: Majority of the study population consisted of females (91%). Mean age of the study population was 44.7 (SD – 12.1). 85.6% of the patients had overt hypothyroidism and 14.4% had subclinical hypothyroidism. The overall prevalence of diabetes mellitus among the study population was 15.6%. Prevalence of impaired fasting glucose was 31%. The prevalence of diabetes, impaired fasting glucose as well as dysglycaemia among patients with overt hypothyroidism and the subclinical hypothyroidism not significantly different (p-0.905, p-0.931, p-0.982). There was no significance difference between the etiology of hypothyroidism and in the prevalence of diabetes and impaired fasting glucose (p- 0.079, p- 0.182 respectively). None of the newly diagnosed patients with diabetes had microvascular complications. Conclusion: Overall prevalence of both overt and subclinical hypothyroidism was not associated with type 2 diabetes mellitus and the severity of hypothyroidism did not have an effect on the development of any form of hyperglycemia. There was no significant association between the etiology of hypothyroidism and in the prevalence of diabetes as well as impaired fasting glucose. Even though the age, the body mass index, the presence of hypertension and the family history were significantly associated with the development of diabetes mellitus, the gender and the sedentary lifestyle did not show a significant association with the development of diabetes in our study population.

Antioxidant and antihyperglycaemic effects of naringenin arrest the progression of diabetic nephropathy in diabetic rats

Background Long-standing diabetes declines the kidney function and is responsible for diabetic nephropathy (DN). The plant and the phytoconstituents have a promising therapeutic potential in the management of diabetes and diabetes complications. Aim This study aimed to evaluate the protective effect of naringenin in diabetic-induced nephropathy in experimental rats. Materials and methods Diabetes was induced in Sprague-Dawley rats fed a high-fat diet and injected with streptozotocin (STZ) (35 mg/kg body weight, intraperitoneal). At 48 h after injection, hyperglycaemia was confirmed by estimating the blood glucose levels and the rats were left untreated for 4 weeks. The diabetic rats were orally treated with different doses of naringenin 25 and 50 mg/kg body weight, for the next 4 weeks. At the end of the treatment body weight and kidney weight were recorded, serum and urine were used for various biochemical estimations. Oxidative stress levels and histopathological studies were performed on isolated kidneys. The efficacy of treatment was statistically analysed with diabetic control rats. Results Increased blood glucose, lipid levels and abnormal kidney functions were noticed in diabetic rats. Moreover, increased levels of oxidative stress markers and altered histological structure were noted in the kidney of diabetic rats, which mimic DN. Naringenin treatments (25 and 50 mg/kg) in diabetic rats significantly restored their kidney functions and reversed hyperglycaemia and lipids level. Hyperfiltration and increased microalbuminuria, urinary albumin excretion and creatinine clearance were effectively attenuated within 4 weeks of naringenin treatments. Increased levels of oxidative stress and histological alteration were restored towards normal. Conclusion Naringenin treatments in diabetic rats arrest the progression of DN due to its multivariate actions such as antihyperglycaemic and antioxidant.