Average Glomerular Filtration Rate Research Articles

Impact of different P2Y12 inhibitors in acute coronary syndrome patients with severe chronic kidney disease: insights from the CORALYS registry

Abstract Background The impact of the most potent P2Y12i ticagrelor and prasugrel after acute coronary syndrome in patients with chronic kidney disease (CKD) remains unclear. Most evidence on dual antiplatelet therapy (DAPT) comes from real-world study but is limited to glomerular filtration rate (GFR) under 60 ml/min whereas no data are available regarding patients with severe CKD (stages IV-V) Methods Consecutive patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI) and severe CKD defined as GFR under 30 ml/min not on dialysis from the CORALYS (Incidence and Predictors of Heart Failure After Acute Coronary Syndrome) registry were included. Incidence of Net Adverse Clinical Events (NACE) defined as major adverse cardiac events (MACE, a composite of cardiovascular death, myocardial infarction and unplanned revascularizations) in addition to major bleedings (classified as BARC scale 3 to 5) was our primary endpoint. Overall MACE and their single components, all bleedings, major bleedings and hospitalizations for heart failure were the secondary ones. Results Of 14699 patients in the CORALYS registry, 257 presented with severe CKD not on dialysis and had available data on antiplatelet regimen at discharge. Patients were divided into two groups according to the type of P2Y12i prescribed at discharge: 193 (75.1%) were given clopidogrel while 64 (24.9%) with ticagrelor or prasugrel. Our populaiton was predominantly male (153, 59.5%) with an average age 75.8 ± 10.9 years old. Average GFR was 21.8 ± 6.3 ml/min. Over a median follow-up of 459 days, Ticagrelor and Prasugrel were associated to lower rates of NACE compared to Clopidogrel (39.9% vs 25.0%, p=0.036). This was mainly driven by an excess of both CV mortality (31.1% vs 6.3%) and myocardial infarction (20.7% vs 9.4%) reported in the clopidogrel group. No difference was reported regarding overall bleeding events (5.7% vs 4.6% with clopidogrel and new P2Y12i respectively, p=0.81) and major bleedings (1.7% vs 4.6% with clopidogrel and new P2Y12i respectively, p=0.15). At multivariate Cox regression analysis DAPT with Ticagrelor/Prasugrel resulted independently associated with a lower risk of NACE (Adj Hr 0.41, 95%CI 0.23-0.74, p=0.003) whereas left main involvement or multivessel coronary disease led to higher risk of NACE (Adj HR 1.96 95%CI 1.21-3.18, p=0.006) Conclusions In ACS patients treated with PCI with severe CKD ticagrelor and prasugrel were associated to lower risk of NACE, MACE, CV death and myocardial infarction compared to clopidogrel. No significative difference was reported in overall and major bleedings despite a relative increase of major bleedings in the group treated with Ticagrelor or Prasugrel.

Impact of Tumor Volume and Other Factors on Renal Function After Partial Nephrectomy.

Background and Objectives: One of the main objectives of partial nephrectomy is to preserve as much renal function as possible. However, the removal of functioning nephrons and ischemic damage secondary to the clamping of the renal pedicle can be associated with a certain degree of renal function loss. We aim to evaluate the relationship between tumor volume and other factors on renal function in the short term (1-3 months) and long term (6-12 months) in our series of partial nephrectomies. Methods: A retrospective study was conducted on 147 patients who underwent open or laparoscopic partial nephrectomy between 2018 and 2022. Tumor volume was estimated through reconstructions from the computed tomography images. Univariate and multivariate analyses of the data were performed. Results: The mean age was 58.2 years, with an average glomerular filtration rate (GFR) of 79 mL/min/m2. Of all partial nephrectomies, 76.2% were laparoscopic, 57.1% were T1a tumors, and the mean volume was 17 cc. The average ischemia time during surgery was 14.3 min, with a mean hemoglobin loss of 2.8 g/dL in the immediate postoperative period. No significant differences were found either in the short or long term regarding ischemia time (p = 0.57, p = 0.32) or tumor volume (p = 0.57, p = 0.33). However, in the multivariate analysis, it was observed that the variable with the greatest influence on short-term renal function was perioperative glomerular filtration, while in the long term, ischemia time, age, and tumor volume also had an influence. Conclusions: Tumor volume is not an independent factor for renal function deterioration in the short or long term. Short-term renal function is primarily determined by perioperative glomerular filtration. Perioperative glomerular filtration, ischemia time, age, and tumor volume can jointly predict long-term renal function.

Predictive Factors of Renal Insufficiency Among Patients with Diabetes and Hypertension in Northeastern Communities of Thailand

The purpose of this study was to study the predictive factors of chronic renal insufficiency in patients with diabetes, hypertension, and diabetes and hypertension in Tajong Subdistrict, Lahan Sai District, Buriram Province. This study, a retrospective case-control study, analyzed data from a 2023 database of patients with chronic diseases in Northeastern Thailand. A study of 4 3 5 community diabetes and hypertension patients analyzed predictive factors of renal insufficiency using SPSS, utilizing descriptive statistics, chi-square, and binary logistic regression analysis. The results showed that the subjects had an average glomerular filtration rate of 73.90 ml/min/1.73m2 (S.D. = 24.02), which was classified as the most abnormal filtration rate of 67.80%. CKD stage 2 (eGFR 60-89 ml/min/1.73m2) is the most. Among patients with diabetics, the predictive equation for renal insufficiency is -2.82+2.808 Age + 4.675BUN. In patients with hypertension, there is a prediction equation for the occurrence of renal insufficiency: -3.391 + 2.246Sex + 2.246Age + 2.637BUN, and in patients with hypertension and diabetics is an equation for predicting the occurrence of renal insufficiency: -4.021 + 1.554sex + 2.023Age + 3.332BUN. It is proposed that gender, age, and BUN all influence the occurrence of renal damage in patients with diabetes, hypertension, and diabetes plus hypertension. As a result, the healthcare team should have standards for assessing risk and preventing renal insufficiency in diabetic and hypertensive patients. Additional research should be conducted to examine the factors associated with kidney deterioration in patients who are unable to control their blood sugar levels.

Effect of Post-Loop Diuretic Urinary Sodium Level on Length of Stay and Rehospitalization in Acutely Decompensated Heart Failure Patients.

In Indonesia, heart failure has become a major community problem because of the high cost of care, low quality of life, and premature death. Until now, loop diuretics are still the main therapy in patients with acute decompensated heart failure with clinical congestion. Diuretic responsiveness can be assessed objectively by measuring sodium urine. This study aimed to determine the response of natriuresis 2 h after loop diuretic administration and its relationship to length of stay and readmission within 30 days in daily clinical practice. This is a prospective cohort study conducted at the National Cardiovascular Center Harapan Kita Hospital in acute decompensated heart failure patients. Patient characteristics were collected from medical records. Response to intravenous (IV) loop diuretics was assessed using urinary sodium laboratory panels. The primary outcomes of interest in this study were length of stay and rehospitalization. Analyses were conducted between the outcome of interests and patient characteristics. There were 51 acute decompensated heart failure patients in this study with 78.4% males. The mean age was 52.47 ± 13.62. The mean ejection fraction was 37.53±17.95%, with the majority of patients having a left ventricular ejection fraction less than 40% (62.7% of study subjects). The average glomerular filtration rate of subjects in this study was 57.29 ± 27.25 mL/min. Pearson correlation test between pre- and post-loop diuretic urinary sodium showed trends of significant correlation (r = -0.238, P = 0.093) and (r = -0.308, P = 0.028), respectively. Patients with lower pre-loop diuretic urinary sodium were shown to have a shorter length of stay (8.57 ± 6.161 vs. 5.30 ± 4.01, P = 0.04), while patients with lower post-loop diuretic urinary sodium showed trends of longer length of stay (8.67 ± 4.14 vs. 6.03 ± 5.39, P = 0.126). In this study, we observe lower rehospitalization in patients with higher pre-loop diuretic urinary sodium levels. Post-loop diuretic urinary sodium level was shown to be inversely related to length of stay in acute decompensated heart failure patients.

1256 Oncological and Urological Outcomes After Total Pelvic Exenteration – Our 10-Year Experience

Abstract Aim Total pelvic exenteration (TPE) is a complex but potentially curative option for advanced pelvic malignancies. This study aims to evaluate long-term outcomes after TPE. Method Between February 2010 and February 2020, 88 patients who underwent TPE at our institution were included. Data extraction was done by retrospective examination of patient records. Incidence of perioperative complications, long-term outcomes and survival were noted. Results The mean age was 62.6 years (29-87 years). Colorectal malignancy (75%) was the most common indication. 63.7% of patients received chemo or radiotherapy or both pre-operatively. Median follow-up was 54 months (33.25 – 80.25 months). At 30 and 90 days, 20.5% and 8% of patients had a Grade 3 complication or above respectively. Complications related to urinary diversion were noted in 10 patients (14 events - 4 urinary leaks, 6 stoma related complications and 4 ileo-ileal anastomotic leaks). The 30- and 90-day mortality rate was 1.1% and 2.3% respectively. At 1, 3, and 5 years, overall survival was 89.8%, 64.8% and 63.6% respectively and cancer specific mortality was 5.7%, 18.2% and 31.8% respectively. Average glomerular filtration rate was 24.2 ml/min/m2 (p<0.0001), 34.1% developing new onset chronic kidney disease 3B or worse and 3.4% requiring haemodialysis. 18.2% of patients required further urological intervention. There was no statistically significant difference in ureteric stricture rates between patients undergoing surgery for recurrent disease (p=0.86) or following prior radiotherapy (p=0.81). Conclusions TPE appears to provide long-term survival in over 60% of patients with advanced pelvic malignancies. Long-term complications are predominantly related to the urinary diversion requiring prolonged urological follow-up.

#1827 Myeloma cast nephropathy: is high cut-off hemodialysis effective?

Abstract Background and Aims Light-chain cast nephropathy is the result of intra-tubular precipitation of light-chains produced by a multiple myeloma. Treatment often includes high cut-off filters hemodialysis (HCO) with the purpose of purifying these chains until the chemotherapy response is achieved. The main goal of this study is to analyze our experience and determine if there is a correlation between the amount of chain purified and the conservation of renal function. Method We conducted a retrospective study that includes all patients suffering from myeloma cast nephropathy treated with hemodialysis in our hospital between 2008 and 2023. HCO filters were used in all of the cases and the diagnosis was established by clinical criteria. In the early stages of the study, only those patients who required kidney replacement therapy underwent dialysis. However, in recent years some cases which did not meet the renal replacement criteria were included. Results 27 patients received the treatment, 59,3% were male and the average age was 68,7+/-8 years. Even though the average of glomerular filtration rate (GFR) previous to the myeloma was 72,65+/-20ml/min, it should be underlined that 8 of them suffered from 3-4 stage chronic kidney disease. The mean follow-up was 55 months, after which 16 had passed away. 59,3% were kappa gammapathy and 75% of them had bone disease. Chemotherapy schemes were variable (85% included Bortezomib). The average of dialysis sessions was 8+/-3,8. 7 patients continued undergoing conventional hemodialysis during the hospital stay but only one of them remained in chronic dialysis. The average GFR at the beginning was 12,2+/-7ml/min. Despite the improvement of the renal function, when compared to the previous GFR, a statistically significant reduction in both hospital discharge (43,67ml/min) and after 1- and 2-year periods (51,94 and 39,91ml/min) was observed. No differences in renal function between patients who started dialysis prematurely (GFR>10ml/min) and those who did not were noticed. The light-chain reduction ratio in each dialysis was examined; it was remarkably variable (2-87%). In order to establish a connection between the amount of chain purified and the preservation of renal function, we conducted a correlation analysis between the intra-dialysis reduction of chains and the GFR at hospital discharge and after 1-year, but not statistically interrelations were observed (p=0,376 and 0,633 respectively). Lastly, no connection between the intra-dialysis light-chain reduction and the loss of GFR was detected. Conclusion In patients with myeloma cast nephropathy, a higher purification of light-chains in HCO hemodialysis is not associated with a better preservation of renal function.

Связь гена GSTP1 с функциональным состоянием почек у больных сахарным диабетом

Introduction of point genetic associations into clinical and laboratory diagnosis will allow the physician to determine the risk of severe diabetes mellitus and its complications with a focus on detection of the genetically determined disorder. The study was aimed to identify the molecular genetic markers of severe diabetic nephropathy in patients with type 1 and 2 diabetes mellitus (DM) based on the GSTP1 (I105V) gene assessment. Genotyping of the GSTP1 gene I105V locus was performed in patients with type 1 and 2 DM. Then we identified the features of oxidative status, free radical oxidation, and renal function in patients with various polymorphic variants of the studied gene. Patients with type 1 DM, who were carriers of the GSTP1 heterozygous polymorphic variant (Ile/Val), showed higher activity of the oxidative stress enzymes (glutathione-S-transferase, catalase) and malondialdehyde compared to homozygous carriers (р < 0.001, р < 0.001, р < 0.05). They also showed a significant increase in the levels of triglycerides (1.6-fold) and the glycated hemoglobin levels (1.1-fold) (p < 0.05). Patients with type 2 DM, who were carriers of the GSTP1 polymorphism homozygous for allele 2 (Val\Val), had a higher level of malondialdehyde (100.5 µmol/L, (р < 0.001)), which was associated with the more severe diabetic nephropathy (average glomerular filtration rate — 48 mL/min/1.73 m2, 24-h urinary albumin excretion — 0.9 g/L; р < 0.01). It has been proposed to assess the GSTP1 (I105V) gene in individuals with type 1 and 2 DM. This polymorphism that is heterozygous in individuals with type 1 DM and homozygous for allele 2 in individuals with type 2 DM is unfavorable in terms of the DM course and complications.

The effect of Renin Aldosterone Angiotensin II System on adrenal glands and glomerular filtration rate in renal failure patients

Renin Aldosterone Angiotensin-2 Systems: Among the most important hormone structures, it controls blood sugar levels, potassium and salt equilibrium, the amount of fluid, and the activities of the urinary tract, the adrenals, and the heart and arteries. The purpose of this investigation is to look at how Renin Aldosterone Angiotensin II affects the glands that produce adrenaline and how it relates to the rate of glomerular filtration in people with persistent kidney disease. The Ibn Sina Centre at Baquba University Hospital is home to 100 Iraqi patients with chronic kidney failure, ranging in age from 35 to 67. The formula was used to get a glomerular filtration rate (GFR). All individuals' blood levels of the hormones renin, testosterone, and angiotensin-2 are measured using a readily accessible ELISA Micro water sources kit from LDN, Germany. The findings demonstrate the relationship among variations in GFR and activity a hormone called ; in the cautious category, the average GFR was substantially inversely correlated with the average activity a hormone called (r=-0.40, p<0.01). The findings demonstrated a relationship among ANGII, aldosterone, and cortisol variations in serum-activated renin, or The average blood activated a hormone called level and the average aldosterone level exhibited an important positive connection in the control group (r=0.33, p<0.05). In contrast, the hemodialysis group (r=-0.12, p>0.05) and the two categories (r=-0.02, p>0.05) showed insignificant negative correlations. In the more cautious group, there was a strong positive correlation (r=0.55, p<0.01) between the mean blood angiotensin level and mean cortisone. In individuals with chronic renal failure, glomerular filtration rate has a detrimental impact on active renin, which in turn has an impact on the adrenal cortex function

The correlation between creatinine levels and estimated glomerular filtration rate (GFR) with blood glucose levels in diabetes mellitus type 2 patients

Diabetes mellitus (DM) was a group of metabolic diseases characterized by hyperglycemia. Measuring the blood creatinine level and calculating the estimated glomerular filtration rate (GFR) was crucial in determining if a person had impaired kidney function. These tests provided valuable insights into the progression of type 2 diabetes mellitus and its associated risk of kidney failure. The objective of this study was to investigate the correlation between average creatinine levels and GFR with blood glucose levels in type 2 DM patients. This correlative research used a cross-sectional approach and included samples from 30 patients with type 2 DM at a hospital in Bandung, Indonesia. The patients' blood glucose and blood creatinine levels were measured using GFR calculations and a Kenza Max photometer, respectively. The sampling method used was accidental sampling, with the sample criteria being type 2 DM patients who were willing to be respondents and did not have hypertension. The average creatinine levels and estimated GFR values were 0.97 mg/dL and 84.971 mL/min/1.73m². The results of the Pearson correlation test indicated non-significant correlations (p > 0.05, p = 0.703 and 0.819). This suggested that there was no significant relationship between creatinine levels and estimated GFR and blood glucose levels in type 2 DM patients. This study provided a foundational exploration of the link between blood glucose levels and kidney function, which could contribute to developing methods for examining kidney diseases in type 2 DM patients. This study's findings underscore the complexity of the relationship between metabolic control and renal function in type 2 diabetes mellitus patients, highlighting the need for individualized patient assessment and management strategies.

Tasa de resangrado vítreo posterior a vitrectomía o facovitrectomía en pacientes con retinopatía diabética proliferativa: estudio retrospectivo

BackgroundThe most common complication after vitrectomy is the rebleeding in vitreous cavity. It is important to detect the different factors that can increase the vitreous rebleeding rate in these patients. ObjectiveTo carry out a retrospective review of the rate of vitreous rebleeding after vitrectomy or phacovitrectomy. MethodRetrospective, descriptive and comparative study of patients with a diagnosis of proliferative diabetic retinopathy with phacovitrectomy or vitrectomy procedure. Personal background data, type of surgical intervention and grade of the surgeon who carried out the procedure were obtained. ResultsOne thousand two hundred twenty-seven files of diabetic patients with vitrectomy or phacovitrectomy were reviewed. Sixty-five percent presented systemic arterial hypertension. The average glomerular filtration rate was 63.50 (±32.36)ml/min/1.73m2 and glycosylated hemoglobin (HBA1C) of 8% (4.6-15%). In the comparison of variables, a significant difference in the rate of vitreous rebleeding was obtained comparing phacovitrectomy with vitrectomy (P=.003), in the relationship between vitrectomy with vitreous rebleeding, an odds ratio of 1.44 was obtained. ConclusionThe results obtained show a lower rate of rebleeding in patients undergoing phacovitrectomy in patients with proliferative diabetic retinopathy.

Vitreous rebleeding rate after vitrectomy or phacovitrectomy in patients with proliferative diabetic retinopathy: A retrospective study

BackgroundThe most common complication after vitrectomy is the rebleeding in vitreous cavity. It is important to detect the different factors that can increase the vitreous rebleeding rate in these patients. ObjectiveTo carry out a retrospective review of the rate of vitreous rebleeding after vitrectomy or phacovitrectomy. MethodRetrospective, descriptive and comparative study of patients with a diagnosis of proliferative diabetic retinopathy with phacovitrectomy or vitrectomy procedure. Personal background data, type of surgical intervention and grade of the surgeon who carried out the procedure were obtained. Results1227 files of diabetic patients with vitrectomy or phacovitrectomy were reviewed. 65% presented systemic arterial hypertension. The average glomerular filtration rate was 63.50 (±32.36) ml/min/1.73 m2 and glycosylated hemoglobin (HBA1C) of 8% (4.6 to 15%). In the comparison of variables, a significant difference in the rate of vitreous rebleeding was obtained comparing phacovitrectomy with vitrectomy. (p = 0.003), in the relationship between vitrectomy with vitreous rebleeding, an odds ratio of 1.44 was obtained. ConclusionThe results obtained show a lower rate of rebleeding in patients undergoing phacovitrectomy in patients with proliferative diabetic retinopathy.

Serum Erythropoietin in Patients with Chronic Renal Failure in the Predialysis Stage

Summary A prospective study was carried out of serum erythropoietin levels in patients with chronic renal failure/chronic kidney disease in the predialysis period. The study is part of scientific project № 2/2022, financed by Medical University-Pleven. Fifty patients were tested – 22 males and 28 females (average age 63.7±13.0), with average serum creatinine 253±127 mcmol/l and average glomerular filtration rate of 22.6±11.8 ml/min/1,72 m2. The results showed that the serum erythropoietin level varied from 1.86 to 48.50 U/l and was below the borderline in only three patients. There were no significant differences between serum erythropoietin and haemoglobin values in both genders. No differences were found between the average haemoglobin values of patients with different values of serum erythropoietin. Non-significant differences were found in the values of serum erythropoietin in patients with different haemoglobin values. A statistically significant difference between the average value of serum erythropoietin was seen in the group of patients who were not undergoing treatment for anaemia with recombinant erythropoietin (8.5±5.9 U/l) and the groups treated with a dose above 3000 UI/weakly (from 18.6±11.3 to 19.7±8.8 U/l).

A Spanish Family with Gordon Syndrome Due to a Variant in the Acidic Motif of WNK1.

(1) Background: Gordon syndrome (GS) or familial hyperkalemic hypertension is caused by pathogenic variants in the genes WNK1, WNK4, KLHL3, and CUL3. Patients presented with hypertension, hyperkalemia despite average glomerular filtration rate, hyperchloremic metabolic acidosis, and suppressed plasma renin (PR) activity with normal plasma aldosterone (PA) and sometimes failure to thrive. GS is a heterogeneous genetic syndrome, ranging from severe cases in childhood to mild and sometimes asymptomatic cases in mid-adulthood. (2) Methods: We report here a sizeable Spanish family of six patients (four adults and two children) with GS. (3) Results: They carry a novel heterozygous missense variant in exon 7 of WNK1 (p.Glu630Gly). The clinical presentation in the four adults consisted of hypertension (superimposed pre-eclampsia in two cases), hyperkalemia, short stature with low body weight, and isolated hyperkalemia in both children. All patients also presented mild hyperchloremic metabolic acidosis and low PR activity with normal PA levels. Abnormal laboratory findings and hypertension were normalized by dietary salt restriction and low doses of thiazide or indapamide retard. (4) Conclusions: This is the first Spanish family with GS with a novel heterozygous missense variant in WNK1 (p.Glu630Gly) in the region containing the highly conserved acidic motif, which is showing a relatively mild phenotype, and adults diagnosed in mild adulthood. These data support the importance of missense variants in the WNK1 acidic domain in electrolyte balance/metabolism. In addition, findings in this family also suggest that indapamide retard or thiazide may be an adequate long-standing treatment for GS.

Measured Glomerular Filtration Rate in Live Related Kidney Donors Three Months Post-Kidney Donation: A Single-Center Experience From Western India.

Background Glomerular filtration rate (GFR) estimation is pivotal in the evaluation of kidney donors. There are various methods available for assessing GFR, but there has been a lack of consensus on the measurement of GFR and the frequency of renal evaluation after kidney donation. Our study aims to analyze the measured GFR (m-GFR) before and three months after kidney donation and note the compensatory abilities of the remnant kidney in live related kidney donors. Methods This prospective observational study was conducted at the Department of Nephrology, Dr. D. Y. Patil Medical College, Hospital & Research Centre,Pune, from April 2021 to December 2022. The study included 30 donors from both genders aged between 23 and 73 years. The measured GFR was calculated using a technetium-99m diethylene triamine pentaacetic acid (Tc-99m DTPA) scan. We analyzed donor characteristics and various parameters that included demography, anthropometry, blood pressure, and serum creatinine and measured GFR(m-GFR) using a Tc-99m DTPA scan, which was compared before and three months after donor nephrectomy. Results Of the 30 donors, 25 (83.3%) were females and five (16.7%) were males. The mean age of donors was 49.23 ± 12.29 years. The mean body mass index (BMI) was noted to be 24.73 ± 5.58 kg/m2, whereas themean body surface area (BSA) was1.59 ± 0.12 m2.In terms of the measured GFR by DTPA scan, pre-donationand post-donation, the average GFR for our population was 103.83 ± 10.07 mL/minute/1.73 m2 and60.47±6.57 mL/minute/1.73 m2, respectively.The mean measured GFR of remnant kidney increased by 9.21 ± 4.39 mL/minute/1.73 m2 in 28 donors, while two donors had a fall in the mean measured GFR by 6.8 ± 1.69 mL/minute/1.73 m2. Conclusions To safeguard donor health, accurate measurement of GFR at various timelines after kidney donation should be consideredas there are various limitations associated with the use ofserum creatinine-based GFR estimating equations for solitary kidneys. However, long-term studies are required to analyze the changes in GFR after nephrectomy and determine the adequacy of compensatory changes in the remnant kidney post-kidney donation.

Correlation with renin-angiotensin-aldosterone and glomerular filtration rate in chronic renal failure patients

Background: One of the more significant hormonal systems, the renin-angiotensin-aldosterone system, controls the kidney function, adrenal gland through its effect on the balance of sodium and potassium, blood pressure, fluid volume, and also manages the functions of cardiovascular.
 Objective: To clarify the interrelationship between renal dysfunction and renin-angiotensin-aldosterone system.
 Patients and Methods: One hundred samples were collected from December 1, 2022, to February 18, 2023, from Al Shams Medical Laboratories (56 male, and 44) female, age range (of 45-60 years), all of them were volunteers suffering from chronic renal failure in the third stage the average glomerular filtration rate was 35. 70 ± 0.37 125 mL/min/1.73m2. and under conservative treatment. Kidney function test, active renin, angiotensin II, and aldosterone were assessed in the serum of all subjects. The p - value of differences less than 0.05 is measured significant, and uses the statistical package for the social sciences (23) software to calculate the correlation coefficient between various parameters.
 Results: The result shows relationship between the changes in GFR with creatinine, urea and active renin, the mean GFR showed significant negative correlated with mean creatinine (R = -0.76, p < 0.01. As well as the mean GFR with mean urea (R = -0.64, p < 0.01). The mean GFR also showed significant negative correlated with mean active renin in (R = -0.41, p < 0.01). Also, the mean serum active renin level was significantly positive correlated with mean aldosterone (R =0.33, p < 0.05).
 Conclusion: Renin enzyme is inversely related to renal dysfunction, so when the glomerular filtration rate decrease, the higher the renin increased, and as a result, the increase in blood pressure in chronic renal failure patients.

Phase 2 Trial of Stereotactic Ablative Radiotherapy for Patients with Primary Renal Cancer

BackgroundMost renal cell carcinomas (RCCs) are localized and managed by active surveillance, surgery, or minimally invasive techniques. Stereotactic ablative radiation (SAbR) may provide an innovative non-invasive alternative although prospective data are limited. ObjectiveTo investigate whether SAbR is effective in the management of primary RCCs. Design, setting, and participantsPatients with biopsy-confirmed radiographically enlarging primary RCC (≤5 cm) were enrolled. SAbR was delivered in either three (12 Gy) or five (8 Gy) fractions. Outcome measurements and statistical analysisThe primary endpoint was local control (LC) defined as a reduction in tumor growth rate (compared with a benchmark of 4 mm/yr on active surveillance) and pathologic evidence of tumor response at 1 yr. Secondary endpoints included LC by the Response Evaluation Criteria in Solid Tumors (RECIST 1.1), safety, and preservation of kidney function. Exploratory tumor cell–enriched spatial protein and gene expression analysis were conducted on pre- and post-treatment biopsy samples. Results and limitationsTarget accrual was reached with the enrollment of 16 ethnically diverse patients. Radiographic LC at 1 yr was observed in 94% of patients (15/16; 95% confidence interval: 70, 100), and this was accompanied by pathologic evidence of tumor response (hyalinization, necrosis, and reduced tumor cellularity) in all patients. By RECIST, 100% of the sites remained without progression at 1 yr. The median pretreatment growth rate was 0.8 cm/yr (interquartile range [IQR]: 0.3, 1.4), and the median post-treatment growth rate was 0.0 cm/yr (IQR: –0.4, 0.1, p < 0.002). Tumor cell viability decreased from 4.6% to 0.7% at 1 yr (p = 0.004). With a median follow-up of 36 mo for censored patients, the disease control rate was 94%. SAbR was well tolerated with no grade ≥2 (acute or late) toxicities. The average glomerular filtration rate declined from a baseline of 65.6 to 55.4 ml/min at 1 yr (p = 0.003). Spatial protein and gene expression analyses were consistent with the induction of cellular senescence by radiation. ConclusionsThis clinical trial adds to the growing body of evidence suggesting that SAbR is effective for primary RCC supporting its evaluation in comparative phase 3 clinical trials. Patient summaryIn this clinical trial, we investigated a noninvasive treatment option of stereotactic radiation therapy for the treatment of primary kidney cancer and found that it was safe and effective.

Recurrent nephrolithiasis and loss of kidney function: a cohort study

PurposeTo evaluate whether symptomatic recurrent nephrolithiasis leads to loss of kidney function.MethodsAdults who presented to the Emergency Department at least twice with symptomatic and radiologically confirmed nephrolithiasis were retrospectively recruited. Primary endpoint was the change in glomerular filtration rate (GFR) between baseline and at the time of data collection. Secondary endpoints include GFR slope defined as the mean rate of change in GFR from baseline to the end of the study period.Results240 patients had recurrent symptomatic nephrolithiasis. Median follow-up was 5.4 years. The median age of first acute presentation was 51.6 years and the median baseline serum creatinine (bsCr) was 85.5 umol/l. 17.5% (n = 42) had worsening GFR, with the average change in GFR of − 8.64 ml/min/1.73 m2 per year. Four patients progressed to ESKD requiring haemodialysis. 14.5% (n = 35) had calcium oxalate stones. Univariate analysis showed older patients (p < 0.001), more symptomatic stone episodes (p < 0.001) and non-calcium-containing stones (p < 0.001) were strongly associated with deteriorating kidney function. Age (p = 0.002) and number of acute stone episodes (p = 0.011) were significant predictive factors when unadjusted to co-morbidities. Age (p = 0.018) was the only predictive factor of worsening GFR when adjusted for co-morbidities. Average mean GFR slope was − 2.83/min/1.73 m2 per year.ConclusionsRecurrent symptomatic nephrolithiasis is associated with loss of kidney function, in older patients, increased episodes of symptomatic nephrolithiasis and non-calcium-containing stones. Age is the only predictive factor for progression to chronic kidney disease in this subgroup.

EFFECTS OF INTRAVITREAL BEVACIZUMAB THERAPY ON GLOMERULAR FILTRATION RATES IN PATIENTS TREATED FOR PROLIFERATIVE DIABETIC RETINOPATHY.

To assess whether the repeated use of intravitreal bevacizumab injections in treatment of proliferative diabetic retinopathy is associated with a long-term decline in the glomerular filtration rate (GFR). Three hundred charts were retrospectively reviewed, of which 60 patients met the criteria for inclusion. The criteria were as follows: reception of at least one bevacizumab injection, baseline GFR before initial bevacizumab injection, and end GFR 6 to 24 months after baseline. Analysis controlled for time between baseline and end GFR measurements, blood pressure, hemoglobin A1C, race, sex, age, and use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Significance testing was performed with step-wise multiple linear regression. The significance threshold was 5%, and all tests were two-sided. Patients received a range of 1 to 17 injections (average 3.6). The average baseline GFR was 76 ± 38 mL/minute, and the end GFR was 63 ± 39 mL/min. The number of injections patients received was not associated with end GFR ( P = 0.72), GFR reduction ( P = 0.88), or percent GFR reduction ( P = 0.49). Increased number of intravitreal bevacizumab injections at therapeutic dosage was not associated with reduced GFR in patients with proliferative diabetic retinopathy. This study supports that intravitreal antivascular endothelial growth factor agents are renally safe.

Epidemiological and biological profiles of chronic renal failed at the University Hospital of Joseph Ravoahangy Andrianavalona in Madagascar

Introduction: Chronic renal failed is an irreversible decline in renal function as measured by glomerular filtration rate. The aim of this study is to describe the epidemiological characteristics of chronic renal failed. Methods: This is a retrospective and descriptive study from January 1, 2019 to December 31, 2020 carried out at the UPFR (Paraclinical Unit of Training and Research) of Biochemistry and the USFR (Care Unit of Training and Research) of Nephrological intensive care of CHU-JRA (University hospital center Joseph Ravoahangy Andrianavalona). All biochemical analysis request forms prescribed by the nephrological intensive care department were included, with clinical information of chronic renal failure and confirmed GFR&lt;60 ml/mn/1.73 m2 on the patient's file. Results: Fifty files were selected. The average age was 50.80 years, with a sex ratio of 1.5. The most affected population generally had a low standard of living. Hypertensive patients were the most common, accounting for 82% of cases, with diabetes in third place with 32% of cases. The mean creatinine level was 1067 µmol/l. The average glomerular filtration rate was 7.25. The uraemia was 44.20 mmol/l. Among the ionic disorders, hyperkalaemia was the most common, accounting for 68% of cases. Of the 78% (n=39) of patients who had a blood count, 92.31% (n=36) had normochromic normocytic anaemia. Conclusion: Chronic renal failed remains a public health problem especially in low income countries. It is always associated with other disturbances of biological parameters that should be monitored and corrected.

Institution of a Bone Health Protocol Using an Intravenous Bisphosphonate During Index Heart Transplant Hospitalization

<h3>Purpose</h3> Steroid exposure is a leading risk factor for osteoporotic bone fractures, and more than 10% of heart transplant patients develop fractures. Bisphosphonates are effective at preventing fractures in the post-transplant population. We assessed the implementation of a prophylactic bone density preservation protocol after heart transplantation. <h3>Methods</h3> This single-center retrospective analysis included 21 consecutive heart transplant recipients (HTRs) from March to September 2021. HTRs were protocolized to receive a loading dose of ergocalciferol (at least four doses of 50,000 units daily) followed by intravenous bisphosphonate (5 mg zoledronic acid [ZA]). Patients were prescribed calcium citrate and vitamin D on discharge. <h3>Results</h3> The 21 consecutive HTRs included 16 men and 5 women (average age 58.1±10.9 years). Of HTRs with a 25-OH-vitamin D level measured in the 90 days prior to ZA administration (57.1%; 12/21), the average level was 24.0±11.6 ng/mL. High-dose ergocalciferol was given to 95.2% (20/21) during index hospitalization. ZA was administered to 95.2% (20/21) during index hospitalization at a median of 11 days post-transplant. ZA was delayed due to impaired renal function until 130 days post-transplant in one patient. Among those receiving ZA during the index admission, the average glomerular filtration rate on the day of ZA administration was 66.6±27.1 mL/min/1.73m2. No fevers or infusion reactions occurred in the 72 hours following ZA administration in any patients. There was no difference in the white blood cell (WBC) count between the day prior to ZA administration (day -1; 8,816±2,930 cells/uL) and the day of ZA administration (day 0; 8,842±2,412 cells/uL), yet the WBC count increased to 10,819±3,651 cells/uL on day +1 and further to 12,771±4,668 cells/uL on day +2 (p = 0.002 and 0.0006 for comparisons to day 0, respectively). Serum calcium levels declined from 8.7±0.4 mg/dL on day 0 to 8.3±0.5 mg/dL on day +4 (p = 0.003). Most patients were discharged with calcium (95.2%; 20/21) and vitamin D (81.0%; 17/21) supplementation. No fractures have been reported. <h3>Conclusion</h3> A bone density protection protocol utilizing index-admission intravenous bisphosphonate therapy coupled with calcium and vitamin D was implemented with reassuring tolerability. Similar approaches may ensure effective bone health pharmacotherapy.