Changes In Creatinine Concentrations Research Articles

The association of withholding or continuing angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers on acute kidney injury after non-cardiac surgery.

Withholding or continuing angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers peri-operatively in non-cardiac surgery remains controversial as they may result in intra-operative hypotension and postoperative organ damage. We included patients prescribed angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers who underwent surgical procedures > 1 h duration under general or spinal anaesthesia from January 2012 to June 2022 in a single centre. We categorised patients by whether these drugs were withheld for 24 h before surgery. We evaluated the association of withholding these drugs before non-cardiac surgery with creatinine concentrations that increased ≥ 26.4 μmol.l-1 in the first 48 postoperative hours (acute kidney injury). We also analysed changes in creatinine concentrations and estimated glomerular filtration rates. Angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers were withheld in 24,285 of 32,933 (74%) patients and continued in 8648 (26%) patients. We used propensity scores for drug discontinuation to match 8631 patient pairs who did or did not continue these drugs: acute kidney injury was recorded for 1791 (21%) patients who continued these drugs vs. 1587 (18%) who did not (OR (95%CI) 1.16 (1.08-1.25), p < 0.001). Intra-operative hypotension was recorded for 3892 (45%) patients who continued drugs vs. 3373 (39%) patients who did not (OR (95%CI) 1.28 (1.21-1.36), p < 0.001). Continuing drugs wasindependently associated with a mean increase in creatinine of 2.2 μmol.l-1 (p < 0.001) and a mean decrease in estimated glomerular filtration rate of 1.4 ml.min.1.73 m-2 (p < 0.001). Continuing angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers 24 h before non-cardiac surgery was associated with intra-operative hypotension and postoperative acute kidney injury.

LC/MS-MS quantification of myo-inositol: a novel biomarker for kidney disease

Abstract Creatinine is the primary biomarker used for assessing kidney function in patients with suspected acute and chronic kidney injury. However, creatinine, a product of muscle creatine metabolism, is an imperfect proxy for renal function because it is subject to non-renal interferences including muscle mass, diet, and medications. Creatinine is particularly problematic as a biomarker of acute kidney injury (AKI) due to relatively high renal function reserve, requiring considerable kidney damage and time for a clinically significant change in creatinine to be detected. Given that AKI and chronic kidney injury (CKD) are associated with high mortality, morbidity, and contribute significantly to health care costs, there is an unmet need for highly sensitive and specific biomarkers for assessing renal function in patients. Myo-inositol oxygenase (MIOX) is a novel biomarker limitedly expressed in the proximal renal tubules. MIOX concentrations are elevated in mice with renal injury and in critically ill patients with AKI. Our previously published studies have demonstrated that elevation in MIOX concentrations precedes changes in creatinine concentrations by approximately 54 hours. Importantly, MIOX facilitates the conversion of myo-inositol to glucuronic acid. We developed a robust LC-MS/MS method to quantify myo-inositol in human plasma, hypothesizing that following renal injury (acute and chronic), plasma concentrations of myo-inositol will increase, and will correlate with increases in serum creatinine concentrations. A healthy outpatient cohort was identified from samples obtained from out-patients with normal plasma creatinine, eGFR&amp;gt;60, as well as normal urine protein: creatinine ratio, albumin: creatinine ratio, or urinalysis results that were pan-negative/pan-normal. Remnant samples from out-patients with clinically staged CKD who have not initiated dialyses were selected for the CKD group. In healthy adult out-patients with stable renal function, the central 95th% distribution of plasma myo-inositol concentrations was 16.61 - 44.2 uM (Median 27.7uM, 95% CI: 26.7-28-7). No sex-based differences in plasma myo-inositol were observed. We also observed excellent correlation between plasma myo-inositol and serum creatinine concentrations (r=0.84, 95% CI: 80-88), as well as excellent sensitivity (99%) and specificity (100%) at a myo-inositol concentration of 50.22uM for differentiating patients with stable kidney function from those with CKD. Patients with CKD exhibited higher plasma myo-inositol concentrations (p value &amp;lt;0.0001) with a central 95% percentile of 51.2-309.1 uM (Median 104.1 uM, 95% CI: 92.3- 113.6). These results imply that myo-inositol concentrations increase in accord with renal injury and MIOX buildup in patients with kidney dysfunction, making it a potential biomarker for renal impairment.

The impact of hypertonic saline on damage control laparotomy after penetrating abdominal trauma.

The inability to achieve primary fascial closure (PFC) after emergency laparotomy increases the rates of adverse outcomes including fistula formation, incisional hernia, and intraabdominal infection. Hypertonic saline (HTS) infusion improves early PFC rates and decreases time to PFC in patients undergoing damage control laparotomy (DCL) after injury. We hypothesized that in patients undergoing DCL after penetrating abdominal injury, HTS infusion would decrease the time to fascial closure as well as the volume of crystalloid required for resuscitation without inducing clinically relevant acute kidney injury (AKI) or electrolyte derangements. We retrospectively analyzed all penetrating abdominal injury patients undergoing DCL within the University of Pennsylvania Health System (January 2015-December 2018). We compared patients who received 3% HTS at 30mL/h (HTS) to those receiving isotonic fluid (ISO) for resuscitation while the abdominal fascia remained open. Primary outcomes were the rate of early PFC (PFC within 72h) and time to PFC; secondary outcomes included acute kidney injury, sodium derangement, ventilator-free days, hospital length of stay (LOS), and ICU LOS. Intergroup comparisons occurred by ANOVA and Tukey's comparison, and student's t, and Fischer's exact tests, as appropriate. A Shapiro-Wilk test was performed to determine normality of distribution. Fifty-seven patients underwent DCL after penetrating abdominal injury (ISO n = 41, HTS n = 16). There were no significant intergroup differences in baseline characteristics or injury severity score. Mean time to fascial closure was significantly shorter in HTS (36.37h ± 14.21 vs 59.05h ± 50.75, p = 0.02), and the PFC rate was significantly higher in HTS (100% vs 73%, p = 0.01). Mean 24-h fluid and 48-h fluid totals were significantly less in HTS versus ISO (24h: 5.2L ± 1.7 vs 8.6L ± 2.2, p = 0.01; 48h: 1.3L ± 1.1 vs 2.6L ± 2.2, p = 0.008). During the first 72h, peak sodium (Na) concentration (146.2mEq/L ± 2.94 vs 142.8mEq/L ± 3.67, p = 0.0017) as well as change in Na from ICU admission (5.1mEq/L vs 2.3, p = 0.016) were significantly higher in HTS compared to ISO. Patients in the HTS group received significantly more blood in the trauma bay compared to ISO. There were no intergroup differences in intraoperative blood transfusion volume, AKI incidence, change in chloride concentration (△Cl) from ICU admit, Na to Cl gradient (Na:Cl), initial serum creatinine (Cr), peak post-operative Cr, change in creatinine concentration (△Cr) from ICU admission, creatinine clearance (CrCl), initial serum potassium (K), peak ICU K, change in K from ICU admission, initial pH, highest or lowest post-operative pH, mean hospital LOS, ICU LOS, and ventilator-free days. HTS infusion in patients undergoing DCL after penetrating abdominal injury decreases the time to fascial closure and led to 100% early PFC. HTS infusion also decreased resuscitative fluid volume without causing significant AKI or electrolyte derangement. HTS appears to offer a safe and effective fluid management approach in patients who sustain penetrating abdominal injury and DCL to support early PFC without inducing measurable harm. Level III.

Creatinine recovery from bovine urine under the effect of different times and temperatures of storage.

Creatinine is a urinary marker used widely in ruminant's experimental trials. However, despite its great importance no data were found in the literature about the best way to store bovine urine samples. In the sheep urine, was observed an increase in the urinary concentration of creatinine when it was stored acidified (pH 2.5 to 3.5) at a temperature of 28 to 39 °C for 150 days of storage. Nevertheless, urine should be stored acidified (pH below 3) to avoid purine derivative degradation, So, aimed to evaluate creatinine recovery in bovine urine as a function of storage time and temperature. A total of 25 animals' urine (10 Nellore cattle and 15 Holstein cattle) were collected. The urine (40 mL) was diluted in 160 mL of distilled water and its pH was corrected to a value lower than 3 using sulfuric acid drops. A sample of the diluted urine was analyzed to obtain the creatinine concentration reference value on the collection day. The remaining urine was fractionated and preserved at room temperature, cooled (4 °C) or frozen (-20 °C and -40 °C). In the urine of five Holstein cattle was added creatine solutions (20, 40 and 60 mg/dL) to evaluate the creatine to creatinine conservation. These urine samples were analyzed on different days after collection (1, 3, 7, 15, 30 and 45 days). The urine without any added creatine was analyzed on Days 1, 3, 7, 10, 15, 30, 45, 60, 90, 120, and 150 of storage. The addition of creatine in the urine caused an increase in the creatinine concentration (P < 0.05) after 30 days of storage at room temperature and under refrigeration (4 °C). In frozen samples, there was no change in creatinine concentration (P > 0.05). However, creatinine recovery was constant (P > 0.05) until day 15 of storage, regardless of the temperature used, when creatine was not added. After 30 days of storage, an effect of time and/or temperature was observed on creatinine recovery (P < 0.05). Urine samples can be stored at any temperature for up to 15 days after collection to estimate the creatinine concentration. Samples that need storage times longer than 15 days should be frozen (at -20 °C and -40 °C) to avoid creatinine concentration variation.

Association of vancomycin plus piperacillin–tazobactam with early changes in creatinine versus cystatin C in critically ill adults: a prospective cohort study

PurposeAlthough dozens of studies have associated vancomycin + piperacillin–tazobactam with increased acute kidney injury (AKI) risk, it is unclear whether the association represents true injury or a pseudotoxicity characterized by isolated effects on creatinine secretion. We tested this hypothesis by contrasting changes in creatinine concentration after antibiotic initiation with changes in cystatin C concentration, a kidney biomarker unaffected by tubular secretion.MethodsWe included patients enrolled in the Molecular Epidemiology of SepsiS in the ICU (MESSI) prospective cohort who were treated for ≥ 48 h with vancomycin + piperacillin–tazobactam or vancomycin + cefepime. Kidney function biomarkers [creatinine, cystatin C, and blood urea nitrogen (BUN)] were measured before antibiotic treatment and at day two after initiation. Creatinine-defined AKI and dialysis were examined through day-14, and mortality through day-30. Inverse probability of treatment weighting was used to adjust for confounding. Multiple imputation was used to impute missing baseline covariates.ResultsThe study included 739 patients (vancomycin + piperacillin–tazobactam n = 297, vancomycin + cefepime n = 442), of whom 192 had cystatin C measurements. Vancomycin + piperacillin–tazobactam was associated with a higher percentage increase of creatinine at day-two 8.04% (95% CI 1.21, 15.34) and higher incidence of creatinine-defined AKI: rate ratio (RR) 1.34 (95% CI 1.01, 1.78). In contrast, vancomycin + piperacillin–tazobactam was not associated with change in alternative biomarkers: cystatin C: − 5.63% (95% CI − 18.19, 8.86); BUN: − 4.51% (95% CI − 12.83, 4.59); or clinical outcomes: dialysis: RR 0.63 (95% CI 0.31, 1.29); mortality: RR 1.05 (95%CI 0.79, 1.41).ConclusionsVancomycin + piperacillin–tazobactam was associated with creatinine-defined AKI, but not changes in alternative kidney biomarkers, dialysis, or mortality, supporting the hypothesis that vancomycin + piperacillin–tazobactam effects on creatinine represent pseudotoxicity.

Biochemical and Pathomorphological Investigations on Rabbits with Experimentally Induced Hepatic Eimeriosis

Abstract The present study aimed to evaluate the changes in concentrations of some biochemical parameters, as well as macro and microscopic alterations during Eimeria stiedae infection in rabbits. The experiment was performed using 12 three-month-old healthy rabbits, randomly allocated into 2 equal groups: G1 (controls, uninfected animals) and G2 (rabbits infected with E. stiedae). Blood samples were collected at time zero (prior to the infection), 6th, 24th, and 48th hours, and also 7th, 14th, 21st, 28th days after the infection. After sampling, the blood was centrifuged, plasma was separated and frozen at -20 ºC until analyzed. Thawed plasma was used for the quantitative determination of haptoglobin (Hp), total protein (TP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), total cholesterol (TC), total bilirubin (TBIL), urea, and creatinine (CREA). The results in infected rabbits revealed a significant increase in Hp, AST, ALT, GGT, TBIL, and TC levels, as well as a significant decrease in ALP and urea. A weak hyperproteinemia was also observed. There were no changes in CREA concentration. At the end of the clinical investigation, all rabbits were humanely euthanized and necropsied. The post-mortem examination of the infected group revealed hepatomegaly, multifocal yellowish nodules diffusely spread over the liver surface and in the parenchyma, considerably dilated bile ducts, and biliary hyperplasia. Given the results obtained from this experiment, it can be affirmed that hepatic eimeriosis in rabbits is a severe parasitic disease leading to significant disturbances of liver histology and resulting changes in the biochemical profile of infected rabbits.

Nano-molecularly imprinted polymers for serum creatinine sensing using the heat transfer method

Serum creatinine concentration is an important clinical measure of kidney function. However, standard methods of detection, such as the Jaffe method or enzymatic assays, suffer several disadvantages, including non-specificity and procedural complexity, or high cost, respectively. In this work, we propose the use of nano-molecularly imprinted polymers (nMIPs) in conjunction with the novel Heat Transfer Method (HTM) as a promising alternative sensing platform to these existing methods for measuring serum creatinine concentration. More specifically, it is shown that creatinine-imprinted nMIPs can be produced using a solid-phase templating method, and that simple drop-casting onto a cheap, disposable substrate can be used in conjunction with HTM to detect creatinine with a limit-of-detection of (7.0 ± 0.5) μM in buffer solutions. Furthermore, the nMIPs are shown to selectively bind creatinine in comparison to several similar molecules, and the sensing platform is demonstrated to be able to detect changes in creatinine concentration in complex blood plasma samples.

Urinary creatinine varies with microenvironment and sex in hibernating Greater Horseshoe bats (Rhinolophus ferrumequinum) in Korea

BackgroundIn temperate regions many small mammals including bats hibernate during winter. During hibernation these small mammals occasionally wake up (arouse) to restore electrolyte and water balance. However, field data on water stress and concentration of bodily fluids during hibernation is scarce. Urinary creatinine concentration has long been used to calibrate urinary hormone concentration due to its close correlation with urine concentration. Therefore, by investigating urinary creatinine concentration, we can estimate bodily fluid concentration. In this study, we investigated changes in urinary creatinine from greater horseshoe bats (Rhinolophus ferrumequinum) hibernating in abandoned mineshafts in two regions in South Korea.ResultsWe collected 74 urine samples from hibernating greater horseshoe bats from 2018 to 2019. We found that urinary creatinine concentration was higher in February and March and then declined in April. There were also indications of a sex difference in the pattern of change in creatinine concentration over the three months. Bats in the warmer and less humid mineshaft had higher urinary creatinine concentrations than bats in the colder and more humid mineshaft.ConclusionsThese results indicate that hibernating bats face water stress as urinary concentration increases during winter and that water stress may vary depending on the microenvironment. Sex differences in behaviour during hibernation may influence arousal frequency and result in sex differences in changes in urinary creatinine concentration as hibernation progresses. Although further behavioural and endocrinal investigations are needed, our study suggests that urinary creatinine concentration can be used as a proxy to estimate the hydration status of bats and the effect of sex and environmental factors on arousal patterns during hibernation.

Real-world direct-acting antiviral treatment in kidney transplant and hemodialysis patients: the EpiTer-2 multicenter observational study

BackgroundPatients who undergo hemodialysis (HD) or kidney transplantation (KTx) previously had limited possibilities for treatment of hepatitis C virus (HCV) infection. Direct-acting antivirals (DAA) give these patients a chance of virus eradication and safe transplantation. The aim of this study was to evaluate the effectiveness and safety of DAA in KTx and HD patients in real-world settings.MethodsSustained virologic response (SVR) and treatment safety were analyzed in KTx and HD patients from the EpiTer-2 database, which included HCV-infected subjects treated with DAA between 2015 and 2019. Additionally, for KTx patients, changes in creatinine concentration, estimated glomerular filtration rate (eGFR), proteinuria within a year after treatment, and changes in the need for calcineurin inhibitors were assessed.ResultsAmong 10,152 patients from the EpiTer-2 database 148 were selected, 85 after KTx and 63 undergoing HD. The most common genotype, 1b HCV, was found in 73% and 86% of patients, respectively. Cirrhosis was noted in 10% and 19%, respectively. The most common DAA regimen after KTx was sofosbuvir/ledipasvir (54%), whereas in HD patients it was ombitasvir/paritaprevir/ritonavir +/- dasabuvir (56%). All patients with available follow-up results achieved SVR. No deaths, kidney loss or acute rejection episodes were noted. The most common adverse effects in both groups were anemia and weakness. One year after treatment, creatinine concentration, eGFR and proteinuria remained stable in the majority of patients.ConclusionDAA treatment of HCV infection demonstrated high effectiveness and safety in hemodialyzed patients and patients who had undergone KTx in this real-world study.

Creatinine is a biochemical marker for assessing how untrained people adapt to fitness training loads.

BackgroundTo study the peculiarities of changes in creatinine concentration in blood serum of untrained men during the prolonged usage of training loads different in volume and intensity, and to determine the value of this biochemical marker for the assessment of adaptive body changes during fitness training.MethodsWe examined 50 untrained men aged 18–20 years who had no contraindications for practicing fitness. Taking into account the aim of the research, we divided these people into two groups: group A and group B. The research participants used training load regimes different in volume and intensity: representatives of group Aused low intensity training load regime (Ra = 0.53) and representatives of group B used high intensity training load regime (Ra = 0.72). To assess the adaptive body changes in the examined contingent, we used the anthropometry method (circumference body size) and bioimpedansometry (body composition indicators). We also determined the features of adaptation-compensatory body reactions to different training loads by means of biochemical control of creatinine concentration in blood serum.ResultsThe obtained results showed a significant increase in basal level of creatinine concentration in blood serum (by 17.6%) of group B representatives fixed after 3 months of practicing fitness in high intensity training load regime (Ra = 0.72). This group representative also revealed the most pronounced manifestation of adaptive body changes confirmed by the results of the maximal muscle strength growth (1RM) and circumference body size, which was almost 2.5 times higher than the results of group A representatives for the same period of time. The parameters indicating the load volume in a set (Wn) were almost 62.0 % higher in group A representatives in comparison with group B during all stages of control. Nonetheless, the highest creatinine concentration in blood serum (by 11.1 % (p < 0.05) was fixed in group A representatives in response to training load after 3 months of practicing. This fact testifies to the important role of the creatine phosphokinase mechanism of energy supply of muscular activity in the conditions of high volume and low intensity training load regime (Ra = 0.53).ConclusionThe analysis of the results obtained during a series of experimental studies indicates the need and feasibility of using the indicator of basal level of creatinine concentration in blood during fitness training, especially in the conditions of high intensity and low volume training load regime (Ra = 0.72), as an informative marker for assessing the process of long-term adaptation.

Repeated measurements of renal function in evaluating its decline in cats.

The aim of this study was to describe the variability in renal function markers in non-azotaemic and azotaemic cats, and also the rate of change in the markers. Plasma creatinine concentration and its reciprocal, glomerular filtration rate (GFR) and urine specific gravity (USG) were studied as markers of renal function in client-owned cats. GFR was determined using a corrected slope-intercept iohexol clearance method. Renal function testing was performed at baseline and a second time point. The within-population variability (coefficient of variation; CV%) was determined at the baseline time point. Within-individual variability (CV%) and rate of change over time were determined from the repeated measurements. Twenty-nine cats were included in the study, of which five had azotaemic chronic kidney disease. The within-individual variability (CV%) in creatinine concentration was lower in azotaemic cats than in non-azotaemic cats (6.81% vs 8.82%), whereas the within-individual variability in GFR was higher in azotaemic cats (28.94% vs 19.98%). The within-population variability was greatest for USG (67.86% in azotaemic cats and 38.00% in non-azotaemic cats). There was a negative rate of change in creatinine concentration in azotaemic and non-azotaemic cats (-0.0265 and -0.0344 µmol/l/day, respectively) and a positive rate of change of GFR in azotaemic and non-azotaemic cats (0.0062 and 0.0028 ml/min/day, respectively). The within-individual variability data suggest creatinine concentration to be the more useful marker for serial monitoring of renal function in azotaemic cats. In contrast, in non-azotaemic cats, GFR is a more useful marker for serial monitoring of renal function. The majority of cats with azotaemic CKD did not have an appreciable decline in renal function during the study.

Effect of Polycystic Ovary Syndrome and Hormones Disorder on Enzymes Gammaglutamyl Transferase, Oxaloacetic Transaminase, and Proteins

Polycystic ovary syndrome (PCOS) is complex metabolic disorder of endocrine gland in women of reproductive age. The present work illustrate the effect of (PCOS) and hormone disturbance on serum enzymes activities, iron status parameters and hormone profile in patient women suffering from, PCOS, acute kidney disease (AKD) with PCOS, acute kidney disease and iron deficiency anemia (IDA). A total of 160 women, include 135 patients and 25 of control apparently healthy group, patients were subdivided into four groups,(G1) consisted of 50 patients of PCOS, (G2) of 30 patients of PCOS with AKD, (G3) of 30 patient of AKD and (G4) involve 25 patients of IDA. The specimens were collected from different hospital in Baghdad city. The patients and control were investigated for enzymes, gammglutamyltrasferase (GGT), glutamic oxaloacetic transaminase (GOT) or aspartate transaminase (AST) & glutamicpyruvic transaminase (GPT) or alanine transaminase (ALT) lactate dehydrogenase (LDH), total serum proteins (TSP), albumin, globulin, total cholesterol (TC), triglyceride (TG), urea, creatinine and uric acid. Also iron status parameters (serum iron, transferrin saturation percent (TS%), transferrin concentration, and total iron binding capacity (TIBC) and ferritin concentration) were estimated. As well as hormone profile (testosterone (TT), Follicle stimulating hormone (FSH), lutinizing hormone (LH), prolactin (PL), estradiol (E), and progesterone (PRG)) were estimated Results revels highly significant increases for AST or GOT, ALT or GPT, and GGT activities P˂0.001, and a change in LDH of G1 and G2 patients were highly increased P˂0.001 as compared with normal. Remarkable rising was detected in TSP of (G1) patient while there is significant decrease in proteins level of (G2) patients in comparison with normal. Patients of (G3) show significant difference in GGT, LDH and protein. There is significant change in LDH and albumin in (G4), and no change in AST, ALT, GGT, and proteins as compared with normal. Triglyceride (TG), total cholesterol (TC), creatinine show very highly significant change for patients of (G1, G2, G3&G4). Patients women with PCOS show no remarkable change in uric acid and urea and a change in creatinine concentration. Serum iron parameters were changed significantly in patients of (G1, G2, G3, and G4) in comparison with healthy control groups. Hormones levels were significantly different in PCOS patients as compared with normal individual. In conclusion there were remarkable changes in the activities of AST, ALT, GGT, and LDH. This is the first time for the estimation of a change in LDH activity in women with (PCOS) this could be due to genetic and envirmental factor and gene mutation. Hormone levels and iron status parameter changed remarkably may be due to metabolic disturbance and abnormality in the function of hypothalamic neurotransmitter.

Dynamics of L-Carnitine in Plasma and Urine in Patients Undergoing Cisplatin Chemotherapy

Background and Aims: Several studies have indicated that cisplatin (cis-diamminedichloroplatinum II; CDDP) causes urinary excretion of <smlcap>L</smlcap>-carnitine (LC). However, the underlying cofactors affecting the increased urinary excretion remain unclear. The present study was performed to evaluate the dynamics of LC in plasma and urine after CDDP chemotherapy and to examine the relations with clinical parameters, such as gender, body mass index (BMI), and renal function. Methods: Twenty-two patients treated with CDDP therapy were selected. Blood and urine samples were taken from patients before starting CDDP treatment (day 0), on the next day (day 1), and on the seventh day (day 7). We measured plasma and urine concentrations of total, free, and acyl-LC, and examined the relationships with gender, age, treatment cycle, skeletal muscle mass, BMI, glomerular filtration rate, and change in creatinine concentration after CDDP administration. Results: Both urinary and plasma concentrations of 3 types of LC increased markedly on day 1 and subsequently reverted to the pre-CDDP level on day 7. There was a positive correlation between the % changes in plasma and urine LC (correlation coefficient 0.59, p = 0.003) on day 1, but no significant relations were seen in other clinical parameters. Conclusions: CDDP transiently increased plasma LC levels. The mechanism seemed to involve recruitment for marked urinary loss of LC. However, these changes in plasma and urinary LC levels were not related to clinical factors, suggesting that the dynamics of LC were independent of preexisting physical parameters.

Diuretic and antioxidant activities of the aqueous extract of leaves of Vepris heterophylla (Engl.) R. Let (Rutaceae) in rats.

Background Vepris heterophylla (Rutaceae) is a medicinal plant used empirically in African traditional medicine for many clinical conditions including edematous disorders and hypertension. V. heterophylla aqueous extract has been used in northern part of Cameroon by traditional healers for the treatment of arterial hypertension. The study aim was to assess the putative diuretic and antioxidant properties of V. heterophylla leaves aqueous extract.MethodsAdult rats were administered with V. heterophylla leaves aqueous extract acutely (24 h) at doses 50, 100, 150, 200 and 250 mg/kg (per os). The two positive control groups received the diuretic drugs furosemide (5 mg/kg) and hydrochlorothiazide (HCTZ, 10 mg/kg), while negative control group received only an equivalent volume of distilled water. Urinary elimination of electrolytes in response to treatments was evaluated, together with changes in concentrations of creatinine, urea, aldosterone, glucose and albumin in urine and plasma. Various urinary indicators of kidney function and plasmatic markers of oxidative stress were also assessed.ResultsThe findings indicated that the aqueous extract of V. heterophylla at doses ranging from 150 to 250 mg/kg caused a significant and dose-dependent increase of urinary water and electrolytes excretion in normal rats. The aqueous extract of the leaves of V. heterophylla accelerated the elimination of overloaded fluid. At the maximum of diuretic response, urinary osmolarity decreased significantly when compared with controls. Oral administration of aqueous extract at different doses produced a significant diuresis and slight increase in electrolytes (Na+, K+ and Cl−) excretion. The results obtained were compared with standard drug-furosemide (5 mg/kg) and hydrochlorothiazide (10 mg/kg). These effects were observed predominantly at 250 mg/kg dose.ConclusionsOur findings strongly suggest that V. heterophylla aqueous extract has diuretic and antioxidant activities, and deserves further studies considering the potential for the treatment of hypertension.

Effect of tetrastarch (hydroxyethyl starch 130/0.4) on plasma creatinine concentration in cats: a retrospective analysis (2010-2015).

Objectives The objective was to determine survival and changes in creatinine concentrations after administration of 6% tetrastarch (hydroxyethyl starch [HES] 130/0.4) vs crystalloids in critically ill cats. Methods The medical records were reviewed for cats admitted to the intensive care unit with at least two plasma creatinine measurements and initial concentrations not exceeding the upper reference interval. Cats were excluded if they had received HES prior to admission or if they had received fluid therapy for <24 h between initial and subsequent measurements. Changes in creatinine concentrations were evaluated as the percentage change from initial values to the maximum subsequent measurements. Cats receiving only crystalloids were assigned to the crystalloid group; cats receiving only HES or HES and crystalloids were assigned to the HES group. Results Ninety-three cats were included in the study (62 in the crystalloid group, 31 in the HES group). The total median cumulative HES dose was 94 ml/kg (range 26-422 ml/kg) and 24 ml/kg/day (range 16-42 ml/kg/day). No difference was detected between the groups for age, sex, body weight or mortality. The HES group had a significantly longer length of hospitalisation ( P = 0.012), lower albumin concentrations ( P <0.001), higher Acute Patient Physiologic and Laboratory Evaluation scores ( P = 0.037) and higher incidence of systemic inflammatory response syndrome ( P = 0.009) and sepsis ( P = 0.013). There was no significant difference in initial, maximum or maximum change in creatinine concentrations between the groups. Moreover, there was no significant difference in maximum change in creatinine concentrations in the subgroups of cats with systemic inflammatory response syndrome or sepsis. Conclusions and relevance In this population of cats, the administration of HES did not result in a significantly greater increase in creatinine from values measured on admission or higher mortality compared with administration of crystalloids. Further prospective studies are needed to assess both safety and efficacy of HES in cats before recommendations can be made.

A retrospective evaluation of contrast-induced kidney injury in dogs (2006-2012).

To evaluate a population of dogs for evidence of contrast-induced nephropathy (CIN). A retrospective case review between 2006 and 2012. A university teaching hospital. A total of 1,217 client-owned dogs that were administered intravenous iodinated contrast agents were reviewed for evidence of CIN. Inclusion required a measured serum creatinine within 1 week prior as well as within 1 week following administration of contrast. Eighty-six dogs with 92 contrast administrations qualified for inclusion. None. CIN was defined as an increase in >44.2 μmol/L (0.5 mg/dL) from baseline creatinine concentration within 1 week following administration of an intravenous iodinated contrast agent. A total of 7.6% of contrast administrations (7/92) fulfilled the definition of CIN. The creatinine postcontrast administration as well as the change in creatinine concentration was significantly higher in the CIN group than in the non-CIN group (median postcreatinine 150 μmol/L [1.7 mg/dL] versus 70.7 μmol/L [0.8 mg/dL], median change in creatinine 53 μmol/L [0.6 mg/dL] versus 0 μmol/L). Patient signalment, initial creatinine, number of total contrast administrations, dose of contrast received, duration of anesthesia, IV fluid administration, administration of nephrotoxic agents, and use or vasopressor therapy were not significantly different between groups. The temporal association between contrast administration and renal injury in these cases highlights the potential for CIN in dogs. Due to the retrospective nature of this study, a causal association between contrast administration and renal injury cannot be determined. A prospective study is needed to further evaluate CIN in dogs.

The analytical change in plasma creatinine that constitutes a biologic/physiologic change

PurposeAccurate and precise measurements of creatinine are necessary to evaluate changes in kidney function related to a decreased glomerular filtration rate (GFR). When serial measurements of creatinine are monitored in an individual, it is useful to know what magnitude of an analytical change in creatinine indicates a true physiologic/biologic change in plasma creatinine that might warrant clinical intervention. MethodsWe compared results between three different methods for creatinine using large chemistry analyzers, two based on alkaline picrate (AP1 and AP2), and one based on dry-slide enzymatic conversion (ENZ). On each of three different segments or days of the study spaced 1–2months apart, we selected 10 different plasma samples having creatinine concentrations ranging from about 0.5mg/dL to 4.5mg/dL (44 to 400μmol/L). Each sample was analyzed in triplicate on each of two same-model analyzers at each institution, then from this data we determined the precision of each model of analyzer. The within-instrument precision of each analyzer was evaluated from the differences between the triplicate results on each sample by each analyzer (mean and SD of the differences). The between-instrument precision was evaluated as the differences between results on the same sample (1, 2, 3, etc.) analyzed on different analyzers of the same model (A and B). This between-analyzer precision data was used to determine both the range and mean±2SD of the differences that could be used to indicate that greater changes in creatinine concentrations would represent a biologic change. ResultsThe within-instrument precision was best for the ENZ method in comparison to the two alkaline picrate rate methods. The between-instrument precision of the 90 consecutive measurements (30 samples×triplicate analyses) between the same-model analyzers were (mean and SD of differences in mg/dL): −0.018 and 0.029 (ENZ); 0.016 and 0.11 (AP1), and −0.058 and 0.071 (AP2). ConclusionsWhile all three of the creatinine methods studied had good precision, the ENZ method had the best precision, such that a change of 0.07mg/dL (6μmol/L) in serial creatinine concentrations up to 1.5mg/dL on a patient could indicate a biologic change had occurred. For the alkaline picrate methods, a measured change of creatinine of 0.23mg/dL for AP1 or 0.11mg/dL for AP2 would indicate that a physiologic change in serum/plasma creatinine has occurred. While a definite biologic change may simply represent daily variations, detecting a biologic change in creatinine more rapidly could impact the ability of creatinine to detect early and clinically significant changes in renal function.

Retrospective evaluation of the effects of administration of tetrastarch (hydroxyethyl starch 130/0.4) on plasma creatinine concentration in dogs (2010-2013): 201 dogs.

To determine changes in creatinine concentrations following the administration of 6% tetrastarch (hydroxyethyl starch [HES] 130/0.4) compared to crystalloids (CRYSs) in critically ill dogs. Retrospective case series (2010-2013). University teaching hospital. Two hundred and one dogs admitted to the intensive care unit with initial plasma creatinine concentrations not exceeding laboratory reference intervals (52-117 μmol/L [0.6-1.3 mg/dL]) and receiving either CRYSs alone (CRYS group, n = 115) or HES with or without CRYSs (HES group, n = 86) for at least 24 hours. None. Creatinine concentrations at admission to the intensive care unit (T0), and 2-13 days (T1) and 2-12 weeks (T2) after initiation of fluid therapy were analyzed. Creatinine concentrations were analyzed as absolute values and as the maximum percentage change from T0 to T1 (T1max%) and from T0 to T2 (T2max%), respectively. Creatinine concentrations were available for 192 dogs during T1 and 37 dogs during T2. The median cumulative dose of HES was 86 mL/kg (range, 12-336 mL/kg). No difference was detected between the groups for age, gender, body weight, and length of hospitalization. Outcome was significantly different between the HES (66% survived) and the CRYS (87% survived) groups (P = 0.014). No significant difference was detected between groups for creatinine concentrations at T0, T1, T2, T1max%, or T2max%. No significant difference was detected between the groups for T1max% creatinine in dogs subclassified as having systemic inflammatory response syndrome or sepsis. HES administration in this canine population did not result in increased creatinine concentrations compared to administration of CRYSs. Further studies are needed to establish the safety of HES in critically ill dogs.

Diuretic and antioxidant activities of the aqueous extract of leaves of Cassia occidentalis (Linn.) in rats.

To assess the putative diuretic and antioxidant properties of Cassia occidentalis (C.occidentalis) leaves' aqueous extract. Adult rats were administered with C.occidentalis leaves aqueous extract acutely (24h) and subchronically (7d), at doses 80, 160, 240, 320, and 400mg/kg (per os). Negative control group received only an equivalent volume of distilled water, while the two positive control groups received the diuretic drugs furosemide (20mg/kg, ip.) and hydrochlorothiazide (HCTZ) (20mg/kg, ip.). Urinary elimination of electrolytes in response to treatments was evaluated, together with changes in concentrations of creatinine, urea, aldosterone, glucose, and albumin in urine and plasma. Various urinary indicators of kidney function and plasmatic markers of oxidative stress were also assessed. The acute administration of C.occidentalis increased the urinary excretion of 107.58% at the higher dose tested, compared to negative control. The reference drugs furosemide and HCTZ induced increases of 84.27% and 48.05%, respectively. Acutely, the extract induced Na(+) and Cl(-) elimination, whereas subchronically an increase in K(+) elimination was also observed. The extract also improved the kidney function indexes and oxidative stress markers. These effects were dose-dependent and comparable with positive control observations. Our findings strongly suggest that C.occidentalis aqueous extract has diuretic and antioxidant activities, and deserves further studies considering the potential for the treatment of hypertension.

Long-term Renal Outcomes of Consecutive Patients Undergoing Open Type IV Thoracoabdominal Aneurysm Repair

To evaluate long-term renal outcomes after open type IV thoracoabdominal aneurysm (TAAA) repair. Retrospective analysis of a prospectively collected database of consecutive operated non-ruptured type IV TAAAs (2007-2011). Renal function was analysed by serum creatinine concentration, estimated glomerular filtration rate (eGFR) and Kidney Disease Outcomes Quality Initiative (KDOQI) stage. The primary outcome was the change in creatinine concentration from before surgery to defined time points after surgery: peak postoperative; discharge; at follow-up (>1 year postoperatively). Secondary outcomes were change in eGFR, change in KDOQI stage, dialysis requirement, and 30-day mortality. Between 2007 and 2011, 53 open type IV TAAA repairs were performed. Median creatinine levels significantly increased in the immediate postoperative period, but returned to baseline by discharge. Thirteen patients (28.2%) had an improvement in follow-up eGFR of at least 20% compared with pre-operative eGFR or improved by one KDOQI stage. Twelve patients (26.1%) had a decline in eGFR of at least 20% or one KDOQI stage at follow-up. Three patients (7.5%) required temporary dialysis and one patient (1.9%) required permanent dialysis. The 30-day mortality was 1.9%. This study demonstrates acceptable renal outcomes following open type IV TAAA repair. Open type IV repair remains the standard against which newer techniques should be compared.