Blood Urea Nitrogen-creatinine Ratio Research Articles

The effect of the concurrent use of Dexmedetomidine (DEX) during the perioperative period on the renal function of patients following craniocerebral interventional surgery

Background Craniocerebral interventional surgery is a common and essential treatment for cerebrovascular diseases. Despite continuous progress in interventional diagnosis and treatment technology, there is no effective method to alleviate contrast-induced kidney injuries. In this retrospective cohort study, we investigated the effect of the concurrent use of Dexmedetomidine (DEX) during the perioperative period on the renal function of patients following craniocerebral interventional surgery. Methods We identified 228 cases of patients underwent craniocerebral interventional surgery from January 2018 to March 2022. Patients who used DEX during general anesthesia were in the DEX group (DEX group) or that did not use dexmedetomidine as the control group (CON group). The markers of kidney injury were recorded before and within 48 h after surgery. Results Compared with CON group, the urea nitrogen (BUN) of the DEX group decreased significantly on the first day and the second day after surgery (p < 0.05). The serum cystatin-C and the blood urea nitrogen/creatinine ratio (BUN/Cr) was significantly lower than that in CON group on the second day (p < 0.05). The urine output in the DEX group increased significantly, and the mean arterial pressure (MAP) was higher than the CON group (p < 0.01). There was no difference in postoperative complications, ICU stay time and hospitalization time between the two groups. Conclusion The combined use of dexmedetomidine in general anesthesia for craniocerebral interventional surgery can reduce BUN levels within 48 h after surgery, significantly increase intraoperative urine volume, maintain intraoperative circulation stability.

Audiological and Vestibular Measurements in Chronic Renal Failure Patients Receiving Hemodialysis Treatment.

The aim was to evaluate the changes in the audiovestibular system in adult patients with the diagnosis of chronic renal failure who were treated with hemodialysis. Thirty-five patients diagnosed with chronic renal failure and receiving hemodialysis treatment 3 days a week and 35 healthy individuals were tested with pure tone audiometry, video head impulse test, and post-head shake nystagmus test. Dizziness Handicap Inventory was applied to all participants. The Dizziness Handicap Inventory scores of the patient groups are higher than the control groups (P=.001). In the video head impulse test, there is no statistically significant difference between the patient and control groups in terms of gain asymmetry. 17.1% of the patients had both left and right lateral saccades (P=.03). A statistically significant difference was also found after the post-head shake test (P=.025). In the patient group, an inverse relationship between the presence of left anterior right posterior saccades and blood urea nitrogen-creatinine ratio and a direct relationship between the presence of right anterior left posterior saccades and creatinine elevation were determined. The presence of saccades in the video head impulse test increased significantly as the disease duration of hemodialysis patients increased. It was determined that the overt and covert saccades in the video head impulse test increased significantly as the creatinine increased and the duration of the disease increased in the patients with chronic renal failure. The common clinical usage of video head impulse test in monitoring the vestibular side effects of creatinine elevation and disease duration in chronic renal failure patients may be possible with future studies.

Plasma levels of intact parathyroid hormone and congestion burden in heart failure: clinical correlations and prognostic role

Abstract Circulating parathyroid hormone (PTH) concentrations increase in heart failure (HF) and are related to disease severity. The relationship between PTH and congestion is still a matter of debate. The objective of this analysis was to evaluate the role of PTH as a marker of congestion and prognosis in HF. We enrolled 228 patients with HF. Intact PTH concentrations and HYDRA score (constituted by: B-type natriuretic peptide, blood urea nitrogen-creatinine ratio, estimated plasma volume status, and hydration status) were evaluated. The study endpoint was all-cause mortality. PTH levels were higher in acute compared with chronic HF and in patients with clinical signs of congestion (i.e., peripheral oedema and orthopnea). PTH concentrations significantly correlated with NYHA class and HYDRA score. At multivariate analysis of HYDRA score, estimated glomerular filtration rate (eGFR), and corrected serum calcium were independently determinants of PTH variability. Fifty patients (22%) died after a median follow-up of 408 days (interquartile range: 283-573). Using univariate Cox regression analysis, PTH concentrations were associated with mortality (hazard ratio [HR]: 1.003, optimal cut-off: &amp;gt;249 pg/mL-area under-the-curve = 0.64). Using multivariate Cox regression analysis, PTH was no longer associated with death, whereas HYDRA score, left ventricular ejection fraction, and eGFR acted as independent predictors for mortality (HR: 1.96, 0.97, and 0.98, respectively). Our study demonstrated that intact PTH was related to clinical and subclinical markers of congestion. However, intact PTH did not act as an independent determinant of all-cause death in HF patients.

The impact of dehydration on short-term postoperative complications in total knee arthroplasty

BackgroundAs healthcare economics shifts towards outcomes-based bundled payment models, providers must understand the evolving dynamics of medical optimization and fluid resuscitation prior to elective surgery. Dehydration is an overlooked modifiable risk factor that should be optimized prior to elective total knee arthroplasty (TKA) to reduce postoperative complications and inpatient costs.MethodsAll primary TKA from 2005 to 2019 were queried from the National Surgical Quality Improvement Program (NSQIP) database, and patients were compared based on dehydration status: Blood Urea Nitrogen Creatinine ratio (BUN/Cr) < 20 (non-dehydrated), 20 ≤ BUN/Cr ≤ 25 (moderately-dehydrated), 25 < BUN/Cr (severely-dehydrated). A sub-group analysis involving only elderly patients > 65 years and normalized gender-adjusted Cr values was also performed.ResultsThe analysis included 344,744 patients who underwent TKA. Adjusted multivariate logistic regression analysis showed that the severely dehydrated cohort had a greater risk of non-home discharge, postoperative transfusion, postoperative deep vein thrombosis (DVT), and increased length of stay (LOS) (all p < 0.01). Among the elderly, dehydrated patients had a greater risk of non-home discharge, progressive renal insufficiency, urinary tract infection (UTI), postoperative transfusion, and extended LOS (all p < 0.01).ConclusionBUN/Cr > 20 is an important preoperative diagnostic tool to identify at-risk dehydrated patients. Providers should optimize dehydration to prevent complications, decrease costs, and improve discharge planning.Level of evidenceLevel III; Retrospective Case-Control Design; Prognosis Study.

Plasma Levels of Intact Parathyroid Hormone and Congestion Burden in Heart Failure: Clinical Correlations and Prognostic Role.

Circulating parathyroid hormone (PTH) concentrations increase in heart failure (HF) and are related to disease severity. The relationship between PTH and congestion is still a matter of debate. The objective of this analysis was to evaluate the role of PTH as a marker of congestion and prognosis in HF. We enrolled 228 patients with HF. Intact PTH concentrations and HYDRA score (constituted by: B-type natriuretic peptide, blood urea nitrogen–creatinine ratio, estimated plasma volume status, and hydration status) were evaluated. The study endpoint was all-cause mortality. PTH levels were higher in acute compared with chronic HF and in patients with clinical signs of congestion (i.e., peripheral oedema and orthopnea). PTH concentrations significantly correlated with NYHA class and HYDRA score. At multivariate analysis of HYDRA score, estimated glomerular filtration rate (eGFR), and corrected serum calcium were independently determinants of PTH variability. Fifty patients (22%) died after a median follow-up of 408 days (interquartile range: 283–573). Using univariate Cox regression analysis, PTH concentrations were associated with mortality (hazard ratio [HR]: 1.003, optimal cut-off: >249 pg/mL—area under-the-curve = 0.64). Using multivariate Cox regression analysis, PTH was no longer associated with death, whereas HYDRA score, left ventricular ejection fraction, and eGFR acted as independent predictors for mortality (HR: 1.96, 0.97, and 0.98, respectively). Our study demonstrated that intact PTH was related to clinical and subclinical markers of congestion. However, intact PTH did not act as an independent determinant of all-cause death in HF patients.

Raised Blood Urea Nitrogen–Creatinine Ratio as a Predictor of Mortality at 30 Days in Spontaneous Intracerebral Hemorrhage: An Experience from a Tertiary Care Center

Spontaneous intracerebral hemorrhage (SICH) accounts for 7.5%-30% of all strokes and carries higher morbidity and mortality. Raised blood urea nitrogen and creatinine ratio (BUNR) is a marker of dehydration and related to poor outcome in stroke patients. However, the ratio varies between 15 and 80 in different studies. The aim of the present study was to assess BUNR as an independent predictor of mortality and its sensitivity and specificity in predicting outcome in the SICH population. Patients above the age of 18 years with SICH who were admitted in the Department of Neurology at Sir Sunderlal Hospital, Banaras Hindu University between January 2018 and July 2020 were enrolled in the study and prospectively followed up. Demographic, clinical, radiological, and outcome parameters were recorded. A total of 217 patients were included. Of these, 137 (63%) were males. Seventy-one patients died during the initial 30 days. Number of patients with intraventricular hemorrhage (IVH; P = 0.003), higher mean intracerebral hemorrhage (ICH) volume (P < 0.001) and midline shift (P = 0.021), and poor Glasgow Coma Scale (GCS) score (<9) (P = 0.040) was more in the group which did not survive. Mean level of urea was significantly lower among survivors than in those who died (P = 0.001). BUNR was also significantly higher in those who died than in those who survived (P = 0.001). BUNR with a cutoff value of 39.17 was significantly associated with mortality at 30 days with a sensitivity and specificity of 61.97% and 62.33%, respectively. On performing two different multivariable logistic studies, it was found that model B with BUNR ratio as a predictor of mortality out performed model A (without BUNR). The study showed that SICH was associated with significant mortality. Independent predictors of death at 30 days were lower GCS on admission, larger hematoma volume, and BUNR of more than 39.17.

Correlation between C-Reactive Protein Level and Blood Urea Nitrogen-Creatinine Ratio in COVID-19 Patients

Coronavirus Disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2).C-Reactive Protein (CRP) is an inflammation marker that increases significantly in COVID-19 patients. SARS-CoV-2 can affectkidney function and increase the Blood Urea Nitrogen (BUN)-creatinine ratio. The previous study showed that CRP andBUN-creatinine ratios could be used as predictors of the severity and survival of COVID-19 patients. This study aimed todetermine the correlation between CRP levels and the BUN-creatinine ratio in COVID-19 patients. A retrospectivecross-sectional study was conducted on 34 COVID-19 patients who were diagnosed by PCR test at Dr. Kariadi Hospital,Semarang from March to September 2020. The Spearman correlation test was used for statistical analysis. The median CRPvalue was 4.59 (0.36-27.48) mg/L and BUN-creatinine ratio was 15.06 (5.79-37.04), while the correlation between CRP andBUN-creatinine ratio showed p=0.003 and r=0.502. There was a moderate positive correlation between CRP level andBUN-creatinine ratio. C-reactive protein plays a role in the infiltration process of inflammatory cells and increases adhesionmolecules, which can directly or indirectly damage kidney function. SARS-CoV-2 can enter the kidney directly through theACE-2 receptor and activate the renin-angiotensin-aldosterone system, which will increase water and sodium absorption inthe renal tubules, passive reabsorption of BUN, and creatinine filtration in the glomerulus resulting in increasedBUN-creatinine ratio.

Prognostic Value of Blood Urea Nitrogen/Creatinine Ratio for Septic Shock: An Analysis of the MIMIC-III Clinical Database.

Background Research has previously been done into the risk factors for mortality in septic shock patients. However, there has been no epidemiological study investigating the effect of the blood urea nitrogen/creatinine ratio (BCR) on the prognosis of critically ill septic shock patients. This study is aimed at determining the relationship between BCR and all-cause mortality in adult septic shock patients. Methods Data were extracted from the MIMIC-III database. The clinical endpoints were 28-, 90-, and 365-day all-cause mortality rates in critically ill septic shock patients. Cox proportional hazards models and subgroup analyses were used to analyze the relationship between BCR quartiles and all-cause mortality in septic shock patients. Receiver operator characteristic (ROC) curves and areas under the ROC curves (AUCs) were calculated to evaluate how accurately BCR predicts the mortality of septic shock patients. Results Among the 2484 septic shock patients extracted from the database, 619, 563, 677, and 625 fell into the first (<14.4 mg/dL), second (≥14.4 mg/dL and <20.0 mg/dL), third (≥20.0 mg/dL and <27.3 mg/dL), and fourth (≥27.3 mg/dL) quartiles of BCR, respectively. Male and white patients accounted for 53.8% (1336 patients) and 74.8% (1857 patients) of the population, respectively. The mean age of the population was 67.7 ± 15.8 years. An inverse M-shaped relationship between BCR and mortality in septic shock patients was identified, with a value of ≥27.3 mg/dL providing the highest risk (HR = 1.596, 95% CI: 1.396-1.824, P < 0.001). In the Cox regression model adjusted for different confounding variables, BCR values in the fourth quartiles were significantly associated with increased mortality, using the first quartiles as a reference. The areas under the ROC curves (AUCs) for BCR plus the Sequential Organ Failure Assessment (SOFA) score and BCR plus Acute Physiology Score III (APSIII) were 0.694 (95% CI: 0.673-0.716) and 0.724 (95% CI: 0.703-0.744), respectively. Conclusion An inverse M-shaped curve was determined between BCR and the mortality of septic shock patients. BCR was identified as a readily available and independent prognostic biomarker for septic shock patients, and higher BCRs were associated with increased mortality in these patients.

Clinical and pathological findings in a Dwarf Red Brocket Mazama rufina (Mammalia: Cetartiodactyla: Cervidae) attacked by dogs

Capture myopathy is a common fatal syndrome in wild ungulates resulting from anthropogenic stressful events such as the capture or transport of specimens. There are, however, few published data on this issue due to predator attacks. The present report describes for the first time the capture myopathy syndrome in a Dwarf Red Brocket Mazama rufina following dog Canis familiaris attack. Clinical signs included pale mucous with increase capillary refill time, tachycardia, tachypnea, hypertension, hypothermia, hypoglycemia, and red brown urine. Muscle tremors, ataxia, prostration, paralysis, and opisthotonus were progressively observed. Laboratory tests showed increased levels of cortisol, creatinine, creatine kinase, lactate dehydrogenase, and potassium; decreased blood urea nitrogen-creatinine ratio; and myoglobinuria. The animal died 72 hours after hospital admission. At necropsy, findings included injuries on both hindlimbs with edema, emphysema, and soft-friable texture in affected muscles, dark kidneys and brown urine in bladder. Histopathological exams were indicative of skeletal-cardiac muscle degenerative lesions and myoglobinuric nephrosis. Immuno-histochemistry revealed myoglobin depletion in degenerate muscles and myoglobin accumulation in renal tissues. We strongly recommend that treatment for capture myopathy be initiated when a wild ungulate is admitted with history of predator attack, since the syndrome may have already established. This report adds to the instances of negative impacts caused by domestic dogs on threatened wildlife species.

Multiparametric approach to congestion for predicting long-term survival in heart failure

BackgroundCongestion is a marker of adverse prognosis in patients with heart failure (HF). In addition to brain natriuretic peptide (BNP), estimated plasma volume status (ePVS), bioimpedance vector analysis (BIVA), and blood urea nitrogen/creatinine ratio (BUN/Cr) are emerging as new markers for congestion. The aim of this study was to evaluate the prognostic value of BNP, ePVS, BIVA, and BUN/Cr in HF. MethodsWe analyzed the data from 436 patients with acute or chronic heart failure (AHF, n=184, and CHF, n=252, respectively). BNP, ePVS, hydration index (HI%), and BUN/Cr were collected from all patients at admission. The endpoint was all-cause mortality. ResultsNinety-two patients died after a median follow-up of 463 days (IQR: 287–669). The cumulative mortality of all of the patients was 21% (31% and 13% in AHF and CHF, respectively, p<0.0001). The optimal cut-offs for death occurrence were BNP: >441pg/mL, ePVS: >5.3dL/gr, HI: >73.8%, BUN/Cr: >25. Multivariate Cox regression analysis maintained an independent predictive value for mortality (HR 2. 1, HR 2.2, HR 2.1, and HR 1.7; C-index 0.756). AHF status was no longer associated with death. Together, these variables explained 40% of the risk of death (R2 adjusted=0.40). Patients with all four parameters below or above their optimal cut-off had mortality rates of 4% and 59%, respectively. ConclusionsBNP, ePVS, BIVA, and BUN/Cr at admission provide independent and complementary prognostic information in patients with HF and, when combined, explain the 40% risk of death in these patients independent from the acute or chronic HF condition.

Predictive value of blood urea nitrogen/creatinine ratio in the long-term prognosis of patients with acute myocardial infarction complicated with acute heart failure.

At present, the long-term prognosis of patients with acute myocardial infarction (AMI) after emergency percutaneous coronary intervention is the focus of attention, and relevant research is actively investigating the risk factors associated with prognosis. Poor prognosis often exists in Patients with AMI complicated with acute heart failure (AHF). In recent years, some studies have found that blood urea nitrogen/creatinine ratio (BUN/Cr) can better predict the prognosis of patients with AHF than single BUN or Cr. The relationship between long-prognosis of patients with AMI, as one of the common causes of AHF, and BUN/Cr is unknown. The main purpose of this study was to determine whether BUN/Cr has a predictive value for long-term prognosis in patients with AMI complicated with AHF.In this study, 389 consecutive patients with AMI were enrolled. According to AHF and a median BUN/Cr at admission of 15.32, the patients were divided into four groups (non-AHF + low BUN/Cr, non-AHF + high BUN/Cr, AHF + low BUN/Cr, and AHF + high BUN/Cr groups). A 1-year follow-up was implemented, and the study endpoint was defined as all-cause mortality. Predictors associated with 1-year mortality were evaluated using the Cox proportional hazard analysis, and the Kaplan–Meier analysis was used to estimate the survival rates.AHF occurred in 163 patients (41.9%) during hospital admission and 29 patients died during the 1-year follow-up. The Cox proportional hazard analysis proved an association between the combination of AHF and high BUN/Cr and mortality; however, the association with AHF + low BUN/Cr was not statistically significant.AHF combined with elevated BUN/Cr is linked with an increased risk of mortality in patients with AMI, which suggests that BNU/Cr has a predictive value for prognosis in patients with AMI complicated with AHF.

Prevalence of impaired renal function in patients of liver cirrhosis with or without spontaneous bacterial peritonitis

Background: Renal Impairment (RI) is a common complication in patients with liver cirrhosis and ascites. Spontaneous Bacterial Peritonitis (SBP) a complication in cirrhosis further aggravates and worsens the scenario. Blood urea nitrogen (BUN)/creatinine ratio (BCR) is one of the common laboratory tests used to distinguish prerenal azotemia (PR) from acute tubular necrosis and proves to be handy in absence of other tests.&#x0D; Objective: To find the prevalence of renal impairment in the patients of liver cirrhosis with or without SBP.&#x0D; Design and Setting: Observational, prospective, single centre study.&#x0D; Methods: Cirrhotic patients with SBP or low Ascitic fluid protein were enrolled. RI was considered if the serum creatinine or urea or both were above the reference range. BCR was obtained for each patient and divided based on BCR &lt;20 and BCR&gt;20. Assessment of variability of BCR values was done by further dividing them into eight subgroups (&lt;10, 10–15, 16–20, 21–25, 26–30, 31–35, 36-40 and &gt;40).&#x0D; Results: 34 patients were enrolled and divided into two groups. Group A with 22 patients with SBP and group B with 12 patients with low ascitic fluid protein. Group A had 77.27% patients with RI and group B had 58.33%. Majority of the patients had BCR&gt;20 group denoting a RI of PR type. Three patients had BCR&gt;40 indicating towards a probable gastrointestinal haemorrhage.&#x0D; Conclusion: This study gives an idea about the common occurrence of renal impairment in the patients of liver cirrhosis and ascites which needs early intervention to improve the prognosis. &#x0D; Keywords: Renal Impairment; Renal failure; Blood urea nitrogen creatinine ratio; BCR Spontaneous Bacterial Peritonitis; Liver cirrhosis

Gestational Geophagia Affects Nephrocardiac Integrity, ATP-Driven Proton Pumps, the Renin⁻Angiotensin⁻Aldosterone System, and F2-Isoprostane Status.

Pregnancy brings about strong cravings for nonfood materials, the gestational toxicities of which are not yet ascertained. In this study, we used rat models to investigate the effect of clay beverage consumption during early and late gestation on p-Type ATPases, nephrocardiac integrity, the antioxidant system, and on the activities of the renin–angiotensin–aldosterone system (RAAS). The rats at early (7th day) and late gestation (20th) were administered single doses (500 mg/kg body weight) of clay beverage and examined using ELISA and spectrophotometry. The gestational clay beverage intake significantly elevated the renal hemodynamics, glomerular filtration rate (GFR), anion gap, urinary output, and blood urea nitrogen–creatinine ratio (BUN/Crt). At early and late gestation, clay beverage consumption elevated the heartbeat, atherogenic index of plasma, cardiac risk ratio, and atherogenic coefficients. Creatinine kinase and troponin levels after clay beverage consumption significantly increased with gestation age, while lactate dehydrogenase elevation was independent of gestation age. Mg2+-ATPase and Na+/K+-ATPase significantly decreased during gestation and were further altered with clay beverage intake. The rats showed higher RAAS activities during early and late gestation stages but greatly decreased activities after clay beverage administration. When F2-isoprostane and malondialdehyde levels were measured, slight elevations were found during pregnancy and were greatly elevated with clay beverage intake, while the glutathione reductase, catalase, and superoxide dismutase levels were decreased. We thus discourage clay beverage consumption throughout the entire pregnancy period because of these profound homeostatic imbalances and organ toxicities associated with its consumption.

The Role of History of Gastro-Duodenal Ulcer in Patients with Upper Gastrointestinal Bleeding

Background: Some scoring systems have been introduced to predict the need for performing urgent endoscopy in patients with upper gastrointestinal bleeding (UGIB). However, in an emergency situation, this intervention is insufficient and cannot easily provide the required treatment. Aim: To identify new risk factors that can predict the need for endoscopic intervention (EI) in UGIB patients. Methods: This is a retrospective cross-sectional study. Patients with UGIB admitted from April 2011 to August 2014 were included. The proportion of cases requiring EI and clinical factors (age, gender, antiplatelet/anticoagulant therapy, history of gastro-duodenal ulcer (GDU), systolic blood pressure, heart rate, hemoglobin, mean corpuscular volume, blood urea nitrogen-creatinine ratio (BUN/Cr ratio), prothrombin time-international normalized ratio, and Glasgow-Blatchford Score (GBS) were analyzed using logistic regression models. Result: Of 378 patients who were included in this study, 180 were found to be with GDU. The proportion of cases requiring EI was significantly higher in those with GDU than in other causes except variceal bleeding (53.5 vs. 37.0%, p < 0.01). Multivariate analysis revealed that a history of GDU was an independent risk factor (OR 1.78, 95% CI 1.06–3.00) in addition to BUN/Cr ratio (OR 1.02, 95% CI 1.00–1.03) and GBS (OR 1.19, 95% CI 1.08–1.33). Conclusion: A history of GDU was an independent risk factor for predicting the need for EI in UGIB in addition to BUN/Cr ratio and GBS.

노인 뇌졸중환자의 수분섭취교육 프로그램의 적용 효과

Purpose: This study was to verify the effects of a fluid therapy education program for aged stroke patients for preventing dehydration, pyuria and bacteriuria. Methods: The study employed a non-equivalent control group pretest-posttest design in quasi experimental basis. Subjects were 38 stroke patients (20 in the experimental group and 18 in the control group) older than 65, hospitalized in a senior care center in S city, Korea. Results: The amount of daily average fluid intake, normal ratio of blood urea nitrogen-creatinine ratio, serum Na + and urine white blood cells were increased significantly in the experimental group. Normal ratio of bacteriuria increased in the experimental group, but not significantly. Conclusion: The education program is considered to be an effective nursing intervention tool for preventing dehydration and urinary tract infections which related to the secondary wellness of aged stroke patients. However, longer term study is necessary for better quality of nursing and developing more specific education programs for aged stroke patients usually hospitalized for a long period of time.

Abstract 286: Prognostic Value of Blood Urea Nitrogen / Creatinine Ratio in Patients Post Myocardial Infarction: Experience From the Survival and Ventricular Enlargement Trial

Introduction: Renal function assessed by serum creatinine-based estimated glomerular filtration rate (eGFR), is an established prognostic marker in the general population and following an acute myocardial infarction. Elevation of the blood urea nitrogen / creatinine ratio (BUN/CR) indicates appropriate renal response to systemic hypoperfusion and suggests acute cardio-renal alteration. We aimed to determine the prognostic value of the BUN/CR for adverse cardiovascular (CV) events and mortality in patients with acute myocardial infarction and left ventricular dysfunction. Methods: We used data from the Survival and Ventricular Enlargement (SAVE) trial that randomized 2231 patients 3 to 16 days following an acute myocardial infarction with left ventricular ejection fraction of ≤ 40% to captopril or placebo. Patients with a creatinine level &gt;2.5 mg/dl were not included in the trial. Patients were categorized according to quartiles of BUN/CR, or as high BUN/CR (if ≥ 20) versus low. Cox proportional hazard regression models were used to evaluate the association of BUN/CR with mortality and adverse CV events. Results: There were 461 patients with high BUN/CR (≥ 20). They were older, more likely to be women, have a lower body mass index, higher eGFR, a prior myocardial infarction and a lower left ventricular ejection fraction at baseline. In univariable analysis, an elevated BUN/CR was associated with an increased risk of heart failure but not with other clinical endpoints (death, CV death, or a composite of death, MI or heart failure). In multivariable models that included age, gender, eGFR, diabetes, Killip class, hypertension, assignment to captopril arm, and left ventricular ejection fraction, a high BUN/CR was not predictive of any endpoint (p&gt;0.5). Conclusion: Although an elevated BUN/CR may represent systemic hypoperfusion, it does not appear to be an independent prognostic marker for adverse CV events and mortality in patients with acute myocardial infarction and left ventricular dysfunction.

Emerging Role of Myeloperoxidase in the Prognosis of Nephrotic Syndrome Patients Before and After Steroid Therapy.

Myeloperoxidase (MPO) is a myelocyte derived iron containing enzyme particularly involved in host defense by destroying foreign micro organisms invading the body. Numerous evidences suggest that MPO is involved in the pathogenesis of many inflammatory diseases, especially atherosclerosis. Present study deals with the role of MPO in the renal function and progression of disease in Nephrotic syndrome patients. Case- Control Study carried out in Kasturba Medical College Hospital, Mangalore, India. Forty newly diagnosed Nephrotic syndrome cases, 40 age and sex matched healthy controls and 15 subjects in Nephrotic syndrome remission, were included in the study. Myeloperoxidase enzyme was assayed by 4 amino antipyrine methods in all the subjects. Other renal parameters like urea, creatinine, Blood Urea Nitrogen (BUN), BUN- Creatinine ratio (BUN/Cr) total protein, albumin, globulin, albumin - globulin ratio (A/G ratio) and estimated Glomerular Filtration Rate (eGFR) were also analysed. 24 hour urine protein-creatinine ratio was estimated in Nephrotic syndrome cases and remission group by turbidimetric assay. Students paired t-test and Wilcoxon Signed Rank test were used for the comparison of the data. Pearson and Spearman analyses were used for correlation of the parameters. MPO levels were found to be high in Nephrotic syndrome cases when compared to healthy controls. Urea, creatinine, BUN, BUN/Cr ratio and eGFR were high in Nephrotic syndrome cases while total protein, albumin, globulin and A/G ratio showed decreased levels. MPO had a positive correlation with creatinine and urine protein-creatinine ratio in Nephrotic syndrome. During remission, MPO levels decreased significantly while total protein and albumin levels increased. Myeloperoxidase enzyme is found to be elevated and it strongly correlated with the severity of disease in Nephrotic syndrome. Further studies can be done to use MPO as a therapeutic target in Nephrotic syndrome to ameliorate the symptoms.

Blood Urea Nitrogen/Creatinine Ratio Identifies a High-Risk but Potentially Reversible Form of Renal Dysfunction in Patients With Decompensated Heart Failure

Identifying reversible renal dysfunction (RD) in the setting of heart failure is challenging. The goal of this study was to evaluate whether elevated admission blood urea nitrogen/creatinine ratio (BUN/Cr) could identify decompensated heart failure patients likely to experience improvement in renal function (IRF) with treatment. Consecutive hospitalizations with a discharge diagnosis of heart failure were reviewed. IRF was defined as ≥20% increase and worsening renal function as ≥20% decrease in estimated glomerular filtration rate. IRF occurred in 31% of the 896 patients meeting eligibility criteria. Higher admission BUN/Cr was associated with in-hospital IRF (odds ratio, 1.5 per 10 increase; 95% confidence interval [CI], 1.3-1.8; P<0.001), an association persisting after adjustment for baseline characteristics (odds ratio, 1.4; 95% CI, 1.1-1.8; P=0.004). However, higher admission BUN/Cr was also associated with post-discharge worsening renal function (odds ratio, 1.4; 95% CI, 1.1-1.8; P=0.011). Notably, in patients with an elevated admission BUN/Cr, the risk of death associated with RD (estimated glomerular filtration rate <45) was substantial (hazard ratio, 2.2; 95% CI, 1.6-3.1; P<0.001). However, in patients with a normal admission BUN/Cr, RD was not associated with increased mortality (hazard ratio, 1.2; 95% CI, 0.67-2.0; P=0.59; p interaction=0.03). An elevated admission BUN/Cr identifies decompensated patients with heart failure likely to experience IRF with treatment, providing proof of concept that reversible RD may be a discernible entity. However, this improvement seems to be largely transient, and RD, in the setting of an elevated BUN/Cr, remains strongly associated with death. Further research is warranted to develop strategies for the optimal detection and treatment of these high-risk patients.

The meaning of the blood urea nitrogen/creatinine ratio in acute kidney injury.

Background.A blood urea nitrogen (BUN)/creatinine ratio (BCR) >20 (0.081 in international unit) is used to distinguish pre-renal azotemia (PRA) and acute tubular necrosis (ATN). However, there is little evidence that BCR can distinguish between these two conditions and/or is clinically useful.Methods.We conducted a retrospective study using a large hospital database. Patients were divided into three groups: ‘low BCR’ (if BCR when acute kidney injury (AKI) developed was ≤20), ‘high BCR’ (if BCR when AKI developed was >20) and ‘no AKI’ if patients did not satisfy any of the Risk, Injury, Failure, Loss and End-stage kidney disease criteria for AKI during hospitalization.Results.Among 20 126 study patients, 3641 (18.1%) had AKI. Among these patients, 1704 (46.8%) had a BCR <20 at AKI diagnosis (‘low BCR’) and 1937 (53.2%) had a BCR >20 (‘high BCR’). The average BCR for the two groups was 15.8 versus 26.1 (P < 0.001). Hospital mortality was significantly less in the ‘low-BCR’ group (18.4 versus 29.9%, P < 0.001). Multivariable logistic regression analysis for hospital mortality (‘no AKI’ as a reference) showed that the odds ratio of ‘high BCR’ (5.73) was higher than that of ‘low BCR’ (3.32).Conclusions.Approximately half of the patients with AKI have a BCR >20, the traditional threshold of diagnosing PRA. Unlike PRA patients who have a lower mortality than ATN patients, high BCR patients had higher hospital mortality compared with low BCR patients, which was confirmed with multivariable analysis. These findings do not support BCR as a marker of PRA.

Serum sodium abnormalities during nonexertional heatstroke: incidence and prognostic values

BackgroundAlthough heatstroke is often associated with dehydration, the clinical significance of serum sodium abnormalities in patients with heat-related illness during heat wave has been poorly documented. MethodWe evaluated 1263 patients (age, 82 ± 15 years; body temperature, 40.1°C + 1.2°C) admitted to emergency departments during the August 2003 heat wave in Paris, having a core temperature greater than 38.5°C and measurement of serum sodium concentrations. Patients were classified according to our previously described risk score of death. ResultsHyponatremia (<135 mmol/L) was reported in 409 (32%) and hypernatremia (>145 mmol/L) in 220 patients (17%). One-year survival was significantly decreased in patients with hypernatremia (45%; P = .004) but not in those with hyponatremia (58%; P = .86) as compared with patients with serum sodium concentration in the reference range (57%). Using Cox regression, only hypernatremia was an independent prognostic factor (hazard ratio, 1.35; 95% confidence interval, 1.09-1.36) when risk score was taken into account. Using logistic regression, 2 variables were independently associated with hyponatremia (heatstroke severity score and blood urea nitrogen–creatinine ratio <100). Conversely, 5 variables were independently associated with hypernatremia (living in an institution, dementia, serum creatinine >120 μmol/L, a blood urea nitrogen–creatinine ratio >100, and absence of long-term diuretic intake). ConclusionsSerum sodium abnormalities are frequently observed in patients with a nonexertional heatstroke during heat wave; however, only hypernatremia should be considered as an independent risk factor of death. Rapid measurement of serum sodium concentration is mandatory to appropriately guide electrolyte resuscitation.