Changes In Creatinine Levels Research Articles

Single-Port Robotic Ureteroenteric Stricture Repair: A Retrospective Cohort Review.

Introduction The objective of this study is to present a series of 16 cases utilizing single-port robot-assisted repair for ureteroenteric anastomosis stricture (UES). To our knowledge, this is the first case series recorded detailing successful single-port UES revision. Methods A retrospective review of all patients under a single surgeon undergoing single-port robotic revision of ureteroenteric stricture following radical cystectomy with urinary diversion at our institutions from September 2020 through July 2024 was performed. Patient demographics and perioperative outcomes were assessed. Results The study consisted of 3 bilateral ureteroenteric strictures and 13 unilateral strictures, more commonly on the left. Stricture length averaged 2.2 cm on the left and 2.1 cm on the right. Surgeries were performed by a single surgeon using the da Vinci SP surgical system (Intuitive Surgical, Sunnyvale, California, US). The type of stricture repair included excision and primary anastomosis (EPA) with Bricker or Wallace reconstruction or Heineke-Mikulicz (HM) repair, although one case involved the necessity of revision ileocalycostomy. Two of the 16 cases were converted from robotic to open due to extensive adhesions. The average procedure length was 265 minutes (148-440). Length of stay (LOS) ranged from 0-46 days, averaging 4.9 days. There were five postoperative complications encountered including two seromas, two incisional hernias, and an episode of urosepsis. Pre- and postoperative changes in creatinine level ranged from -0.26 to 0.3 mg/dL. No renal units were lost.No patients were readmitted following initial surgical discharge. All patientsreturned for follow-up; none required repeat intervention. Conclusion SP robotic repair of ureteroenteric anastomoses is safe and feasible. The risk of complications is low with a high chance of success and possibly a lower length of stay;more research is warranted.

Factors associated with acute kidney injury after on-pump coronary artery bypass grafting

BackgroundAcute kidney injury (AKI) frequently occurs as a complication of cardiac surgery and cardiopulmonary bypass (CPB). Its prevalence and severity are determined by various preoperative and intraoperative factors. The aim of this study was to examine the risk factors for AKI following on-pump coronary artery bypass grafting (CABG).MethodsA retrospective analysis of clinical records from a single medical center was performed. The primary determinant for AKI analysis was the creatinine-level changes within the first 48 h after surgery. Records of 120 patients from a prospective cohort study were examined.ResultsAn AKI incidence of 26% occurred in the study cohort. The univariate analysis revealed that patients who developed AKI had notably higher EuroSCORE II values (2.00 ± 0.98 vs. 1.49 ± 0.74, p = 0.006) and higher initial levels of urea (7.62 ± 2.94 vs. 6.12 ± 1.71, p = 0.002) and creatinine (0.108 ± 0.039 vs. 0.091 ± 0.016, p = 0.003). Additionally, they exhibited a more frequent occurrence of initial albumin levels below 40 g/l (9 (34.6%) vs. 11 (14.9%) cases, p = 0.030) and a lower initial hemoglobin level (137.8 ± 13.2 g/l vs. 146.6 ± 13.6 g/l, p = 0.005) in comparison to patients without this complication. Moreover, those with AKI had a significantly longer hospital stay duration (14.3 ± 5.45 days vs. 12.6 ± 3.05 days, p = 0.048). Logistic regression indicated one risk factor, oxygen delivery during CPB, that correlated with the onset of AKI in the early postoperative period.ConclusionThe prevalence of AKI was higher among patients with a higher EuroSCORE II, lower preoperative hemoglobin, increased preoperative levels of creatinine and urea, infrequent albumin levels below 40 g/L, diminished oxygen delivery during CPB, and greater need for RBC transfusion and furosemide, but it did not correlate with the duration of CPB.

A Systematic Review and Meta-Analysis of MicroRNA as Predictive Biomarkers of Acute Kidney Injury.

Acute kidney injury (AKI) affects 10-15% of hospitalised patients and arises after severe infections, major surgeries, or exposure to nephrotoxic drugs. AKI diagnosis based on creatinine level changes lacks specificity and may be delayed. MicroRNAs are short non-coding RNA secreted by all cells. This review of studies measuring miRNAs in AKI aimed to verify miRNAs as diagnostic markers. The study included data from patients diagnosed with AKI due to sepsis, ischaemia, nephrotoxins, radiocontrast, shock, trauma, and cardiopulmonary bypass. Out of 71 studies, the majority focused on AKI in sepsis patients, followed by cardiac surgery patients, ICU patients, and individuals receiving nephrotoxic agents or experiencing ischaemia. Studies that used untargeted assays found 856 differentially regulated miRNAs, although none of these were confirmed by more than one study. Moreover, 68 studies measured miRNAs by qRT-PCR, and 2 studies reported downregulation of miR-495-3p and miR-370-3p in AKI patients with sepsis after the AKI diagnosis. In three studies, upregulation of miR-21 was reported at the time of the AKI diagnosis with a significant pooled effect of 0.56. MiR-21 was also measured 19-24 h after cardiac surgery in three studies. However, the pooled effect was not significant. Despite the considerable research into miRNA in AKI, there is a knowledge gap in their applicability as diagnostic markers of AKI in humans.

#1994 Analysis of dynamics of parameters of safety and effectiveness of rivaroxaban in patients with stage IV chronic kidney disease and atrial fibrillation

Abstract Background and Aims Research in the field of comorbidity of chronic kidney disease (CKD) and atrial fibrillation (AF) is becoming increasingly relevant, especially given the continuously increasing prevalence of this arrhythmia and its contribution to the risk of adverse events, the unity of factors in the development and progression of these diseases. This comorbidity is accompanied by an increased risk of thromboembolic complications (TEC) and atherothrombotic events, as well as the incidence of bleeding during anticoagulant therapy (ACT), which undoubtedly underlies the higher rates of cardiovascular and overall mortality in this cohort of patients. In this regard, we set the following goal: analysis of the dynamics and assessment of the safety parameters and effectiveness of the use of rivaroxaban in patients with a glomerular filtration rate (GFR) of 15–29 ml/min/1.73 m2 with non-valvular atrial fibrillation. Method The medical records of 12,026 patients were analyzed; non-valvular AF was diagnosed in 3,715 cases. 502 (15%) patients had stage IV CKD or a sustained decrease in GFR to 15–29 l/min/1.73 m2 during hospitalization. Of these, 109 (3%) patients met the inclusion criteria and were randomized 2:1 to rivaroxaban 15 mg (n = 73) or warfarin (n = 36). The average follow-up period was 18 months. Of the 109 included patients, 2 refused to participate in the study, contact with 9 was lost, 8 patients started taking another direct oral anticoagulant, CKD progressed to stage V in 4 patients, and antiplatelet agents were added in 6 cases. Results To assess the dynamics of changes in creatinine levels and GFR, mixed linear models were constructed, where the individual dynamics of each patient's indicators were selected as random effects, and time and drug intake were selected as fixed effects. A graphical interpretation of the dynamics and differences is presented in Figs 1 and 2. There was a significant improvement in the dynamics of creatinine and GFR in the rivaroxaban group compared to the warfarin group: while patients receiving rivaroxaban had an increase in GFR and a decrease in creatinine levels, patients taking warfarin, on the contrary, showed inverse dynamics in renal function indicators. It should be noted that during the study, a transition from stage IV CKD to stage III was recorded in 43% of patients in the rivaroxaban group and in 34% in the warfarin group (p = 0.26). There were no significant differences in the incidence of any acute cerebrovascular accident, myocardial infarction and all-cause mortality (warfarin—1.4%; 6.9%; 6.8% versus rivaroxaban—5.6%; 2.85; 8.3% (p = 0.25; 0.66; 0.78). Patients taking warfarin were significantly more likely to develop minor bleeding compared to rivaroxaban (36.9% versus 61.1% (p = 0. 01)) and all clinically significant bleeding (10.9% vs. 27.7% (p = 0.03)) according to the ISTH scale. In the warfarin group, TTR>70% was achieved in 94% of patients. All-cause readmission rates were 43% in the rivaroxaban group and 48% in the warfarin group (p = 0.57). Among these patients, 36.9% and 40.7% (respectively) were hospitalized for emergency reasons (p = 0.96). Conclusion In patients with atrial fibrillation and a low glomerular filtration rate (eGFR <30 ml/min/1.73 m2), it is reasonable to consider the use of rivaroxaban based on the current study showing a slower rate of decline in renal function, as well as favorable efficacy and safety profiles of rivaroxaban compared with warfarin in this group of patients.

#2653 Long term renal outcome of patients with idiopathic membranous nephropathy – Croatian single center cohort

Abstract Background and Aims Membranous nephropathy (MN) is the most prevalent cause of nephrotic syndrome in adult population. Our aim was to assess long term renal outcome of primary membranous nephropathy patients. Method In this retrospective study adult patients with biopsy proven membranous nephropathy from 2000 till 2015 with follow up of at least 5 years from UHC Zagreb were included. Extensive clinical workup was done to exclude patients with secondary MN. Except otherwise stated, data are shown as N (%) or median with interquartile range (IQR) and accompanied p levels. Results Between 2000 and 2015, 48 patients were diagnosed to have idiopathic/primary membranous nephropathy, out of which 33 (68%) MN patients had follow up of at least 5 years and where further analyzed. They were predominantly male 20 (60.6%) of average age of 52 years (min – max 19 - 76). High risk MN patient 25 (75%) were treated with immunosuppressive therapy, dominantly with cyclophosphamide and corticosteroids. During the median follow up of 10 (7 – 14) years, 19 (57%) accomplished complete remission and 11 (33%) partial remission. One (3%) patient did not achieve remission and 2 (6.1%) were in relapse of nephrotic syndrome at last follow up. Proteinuria significantly decreased (6.2 (3.3 – 10.9) vs. 0.2 (0.14 – 0,90); p < 0.001) and there was no significant change in creatinine level (87 (42.8 – 101.5) vs. 93 (68.5 – 140.5; p = 0.332)). In follow up there were 5 (15%) carcinomas detected; one of each origin (colon, pancreas, lung, prostate, lymph nodes) approximately 7,8 years after the diagnose of MN. Limitation of this study could be selection bias but there was no difference in renal function at presentation of all MN patients and those who had at least 5 years follow up. Conclusion Renal long-term outcome of patients with idiopathic MN in our cohort was excellent. Nevertheless, there is high prevalence of cancer and therefore regular screening for cancer disease should take place in this population of patients. Also, drugs with cancerogenic potential should be avoided, as well as bear in mind cumulative dose of drugs applied.

Ambulatory Percutaneous Nephrolithotomy: Initial Series in Iran

Background: Percutaneous nephrolithotomy (PCNL) procedures in the United States typically cost between 9000 to 16000 USD. In developing countries like Iran, healthcare performance is hindered by issues such as high bed occupancy rates. Therefore, performing PCNL in an outpatient setting could significantly reduce surgical costs and improve healthcare outcomes by reducing bed occupancy and associated complications. Objectives: This study aimed to explore the feasibility of same-day discharge for selected PCNL patients. Methods: Out of 142 patients, 32 were discharged within 12 hours post-operation (Study Group), while 32 randomly selected patients from the remaining 110 served as the control group. Same-day discharge criteria included stable vital signs, tolerance to oral intake, appropriate mobility, and normal laboratory results. Exclusion criteria encompassed the need for red blood cell transfusion, hemoglobin drops exceeding 2 mg/dL, and abnormal post-operative laboratory findings. Results: Patient characteristics and medical histories did not significantly differ between the study and control groups. Additionally, stone laterality (P-value = 0.606), location (P-value = 0.731), size (P-value = 0.334), and density (P-value = 0.065) showed no significant differences between the two groups. The post-surgical observation period in the study group (mean: 7.88 hours) was significantly shorter than that in the control group (mean: 62 hours) (P-value < 0.001). The mean hemoglobin level change was 1.48 mg/dL (SD: ± 1.02) in the study group and 1.31 mg/dL (SD: ± 0.91) in the control group. Similarly, the change in creatinine levels was 0.13 ± 0.04 in the study group and 0.23 ± 0.03 in the control group. Conclusions: This study demonstrates that outpatient PCNL procedures are feasible without increasing perioperative complications. However, careful patient selection based on strict criteria is crucial for successful implementation.

Effectiveness of urea administration for the treatment of hyponatremia in heart failure

ObjectivesTo assess the efficacy and safety of urea in patients with hyponatremia and heart failure (HF). Methods and resultsThis is a retrospective observational analytical study of patients with HF and hyponatremia (Na+ <135 mmol/l). Forty-nine patients treated with urea and 47 patients who did not receive urea, all under standard treatment (according to usual clinical practice) for HF, were included and followed up at Álvaro Cunqueiro Hospital in Vigo between January 2013 and May 2022. The study evaluated the normalization of sodium levels (Na > 135 mmol/l). The initial natremia at the start of oral urea treatment was 127 ± 5.22 mmol/l, at 24 h the sodium level was 128 ± 2.47 (p < 0.009), and the mean on the day of normalization was 135.19 ± 4.23 mmol/l (p < 0.005). The average number of days to achieve sodium normalization was 5.03 ± 2.37 days. The initial uremia at the start of urea treatment was 73 ± 46.93 mg/dl, and the mean on the day of Na + normalization was 116.05 ± 63.64 mg/dl (p < 0.002). The average oral urea dose was 22.5 g/day. No relevant adverse effects were observed, nor were there significant changes in creatinine levels. ConclusionsOral urea treatment, when added to standard treatment for short periods of time, is safe and effective in correcting natremia in patients with hypervolemic HF with hyponatremia.

Progression of obstructive sleep apnoea after renal denervation is not associated with hypertension exaggeration

PurposeIn a cohort, observational prospective trial, we assessed the long-term dynamics of sleep-disordered breathing in patients with resistant hypertension after renal denervation and their association with blood pressure change at remote follow-up.Materials and methodsTwenty-eight patients with stable hypertension who were recruited for endovascular radiofrequency renal denervation in 2012–2019 and had valid both baseline and follow-up sleep study, were included in the analysis. All patients underwent physical examination, anthropometry, office and ambulatory blood pressure measurements, blood and urine tests, kidney visualization, and full polysomnography before and within 12–36 months after renal denervation.ResultsThe average follow-up comprised 30.1 ± 8.4 months. At long-term follow-up, no significant changes in creatinine level, estimated glomerular filtration rate, body mass index were registered. There was a significant increase in sleep apnea severity indices: the mean change in apnea-hypopnea index comprised 9.0(-21.1;25.2) episodes/h, in oxygen desaturation index 6.5(-16.8;35.9) episodes/h, in the average SpO2 -1.7(-5.6;1.9)%. Over 12-month follow-up, there were no significant differences in blood pressure response in patients with and without sleep apnea. The baseline apnea-hypopnea and oxygen desaturation indices and the mean SpO2 were associated with the circadian blood pressure profile at follow-up, but did not correlate with the blood pressure response.ConclusionsAlthough the severity of sleep apnea worsens at > 12 months follow-up after renal denervation, this is not associated with hypertension exaggeration.

Efectividad de la administración de urea para el tratamiento de la hiponatremia en la insuficiencia cardiaca

ObjectivesTo assess the efficacy and safety of urea in patients with hyponatremia and heart failure (HF). Methods and resultsThis is a retrospective observational analytical study of patients with HF and hyponatremia (Na+ <135mmol/L). Forty-nine patients treated with urea and 47 patients who did not receive urea, all under standard treatment (according to usual clinical practice) for HF, were included and followed up at Álvaro Cunqueiro Hospital in Vigo (Spain) between January 2013 and May 2022. The study evaluated the normalization of sodium levels (Na >135mmol/L). The initial natremia at the start of oral urea treatment was 127±5.22 mmol/L, at 24h the sodium level was 128±2.47 (P<.009), and the mean on the day of normalization was 135.19±4.23mmol/L (P<.005). The average number of days to achieve sodium normalization was 5.03±2.37 days. The initial uremia at the start of urea treatment was 73±46.93mg/dL, and the mean on the day of Na+ normalization was 116.05±63.64mg/dL (P<.002). The average oral urea dose was 22.5g/day. No relevant adverse effects were observed, nor were there significant changes in creatinine levels. ConclusionsOral urea treatment, when added to standard treatment for short periods of time, is safe and effective in correcting natremia in patients with hypervolemic HF with hyponatremia.

Effects of aminophylline therapy on urine output and kidney function in children with acute kidney injury

BackgroundAcute kidney injury (AKI) is a frequent complication of children admitted to the paediatric intensive care unit. One key management modality of AKI is the use of diuretics to reduce fluid overload. Aminophylline, a drug that is well known for its use in the treatment of bronchial asthma, is also purported to have diuretic effects on the kidneys. This retrospective cohort study assesses the effect of aminophylline in critically ill children with AKI.MethodsA retrospective chart review of children admitted to the paediatric intensive care unit of the Red Cross War Memorial Children’s Hospital (RCWMCH) with AKI who received aminophylline (from 2012 to June 2018) was carried out. Data captured and analyzed included demographics, underlying disease conditions, medications, urine output, fluid balance, and kidney function.ResultsData from thirty-four children were analyzed. Urine output increased from a median of 0.4 mls/kg/hr [IQR: 0.1, 1.1] at six hours prior to aminophylline administration to 0.6 mls/kg/hr [IQR: 0.2, 1.9] at six hours and 1.6 mls/kg/hr [IQR:0.2, 4.2] at twenty-four hours post aminophylline therapy. The median urine output significantly varied across the age groups over the 24-h time period post-aminophylline, with the most response in the neonates. There was no significant change in serum creatinine levels six hours post-aminophylline administration [109(IQR: 77, 227)—125.5(IQR: 82, 200) micromole/l] P-value = 0.135. However, there were significant age-related changes in creatinine levels at six hours post-aminophylline therapy.ConclusionsAminophylline increases urine output in critically ill children with AKI.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Red cell distribution width is an inflammatory predictor marker of contrast induced nephropathy in patients undergoing percutaneous coronary intervention

Red blood cell distribution width (RDW) is an inflammatory biomarker reported in complete blood cell (CBC) counts. High RDW defines a proinflammatory state. Contrast-induced nephropathy (CIN) is an important and common complication in percutaneous coronary intervention (PCI) treated patients. The current study was conducted to evaluate the role of RDW as a simple predictive inflammatory marker of CIN in PCI treated patients. The current prospective study enrolled 126 PCI treated patients. Laboratory investigations included CBC, liver function test, (HbA1C), lipid profile and serological tests. Serum urea and creatinine levels were obtained at baseline and 48 to 72 hours after PCI procedure, used to categorize for CIN. Diabetes mellitus, hypertension, and ischemic heart disease were present in 39 (31%), 44 (34.9%), and 23 (18.3%) patients, respectively. Of the studied patients, only 19 (15.1%) patients developed CIN. The hemoglobin level was significantly higher in the non-CIN group (13.49 ± 1.63 vs. CIN group 12.56 ± 1.62 mg/dl; p= 0.02). RDW was significantly higher among CIN group than non-CIN group (16.20 ± 2.60 vs. 13.83 ± 2.19 % (p&lt; 0.001). Delta creatinine (% change in creatinine level after 48 hour) was significantly higher in patients with CIN (59.17 ± 28.89 vs. non-CIN 33.62 ± 9.76; p&lt; 0.001). Predictors for CIN in patients who underwent PCI were old age high RDW high delta creatinine and amount of dye. At cut off &gt; 14.5%, RDW had 79% sensitivity, 70% specificity and 71.3% overall accuracy at AUC of 0.76. In conclusion, RDW may be simple and immediately available inflammatory biomarker and predictor for development of CIN in patients undergoing PCI.

Evaluation of kidney injury through early markers in canine pyometra

Fourteen female dogs diagnosed with pyometra were studied at three separate times: at diagnosis (T0) and 24 h (T1) and 10-15 days (T2) after ovariohysterectomy (OH). The means of the markers, symmetric dimethylarginine (SDMA) (17.71 to 26.54 μg/dL) and the urinary gamma-glutamyl transferase to creatinine ratio (uGGT/uCr) (1.06 to 2.62 U/mg), varied, showing an increase with time. Further, the elevation of gamma-glutamyl transferase (uGGT) (56.61 to 128.12 U/L) and the urinary protein to creatinine ratio (RPC) (0.26 to 1.24) was evident at T0 and T1. A reduction in the means of RPC, uGGT, and uGGT/uCr was observed 10-15 days after OH. Despite the elevation of these markers, the concentration of creatinine (1.11 to 1.40 mg/dL), urea (40.07 to 67.16 mg/dL), and urinary specific gravity (1.027 to 1.028) only presented slight variation. In canine pyometra, complications secondary to acute renal injury may be present that may be mild and transient in most treated animals. As elevation in SDMA and RPC preceded changes in creatinine levels for the evaluation of glomerular filtration, tubular markers could assist in the early identification of renal damage in canine pyometra.

Oral Sodium to Preserve Renal Efficiency in Acute Heart Failure: A Randomized, Placebo-Controlled, Double-Blind Study

Evidence for modulating the sodium chloride (NaCl) intake of patients hospitalized with acute heart failure (AHF) is inconclusive. Salt restriction may not benefit; hypertonic saline may aid diuresis. To compare the safety and efficacy of oral NaCl during intravenous (IV) diuretic therapy in renal function and weight. Seventy hospitalized patients with AHF who were being treated with IV furosemide infusion consented to receive, randomly, 2 grams of oral NaCl or placebo 3 times a day in a double-blind manner during diuresis. Treatment efficacy (bivariate primary endpoints of change in serum creatinine levels and change in weight) was measured at 96 hours, and adverse safety events were tracked for 90 days. Sixty-five patients (34 NaCl, 31 placebo) were included for analysis after 5 withdrew. A median of 13 grams of NaCl was given compared to placebo. At 96 hours, there was no significant difference between treatment groups with respect to the primary endpoint (P = 0.33); however, the trial was underpowered, and there was greater than expected standard deviation in weight change. The mean change in creatinine levels and weight was 0.15 ± 0.44 mg/dL and 4.6 ± 4.2 kg in the placebo group compared with 0.04 ± 0.40 mg/dL and 4.0 ± 4.3 kg in the NaCl group (P = 0.30 and 0.57, respectively). Across efficacy and safety endpoints, we observed no significant difference between the 2 groups other than changes in serum sodium levels (-2.6 ± 2.7 in the placebo group and -0.3 ± 3.3 mEq/L in the NaCl group; P < 0.001) and in serum blood urea nitrogen levels (11 ± 15 in the placebo group; 3.1 ± 13 mEq/L in the NaCl group; P = 0.025). In this single-center study, liberal vs restrictive oral sodium chloride intake strategies did not impact the safety and efficacy of intravenous diuretic therapy in patients with AHF. (ClinicalTrials.gov registration NCT04334668.).

Medication use and hospital-acquired acute kidney injury: an electronic health record-based study.

Medications remain an important contributor to the development of acute kidney injury (AKI). This study aimed to examine associations between (i) administration of medications known to reduce glomerular filtration rate (GFR), that is, GFR modifiers and subsequent hospital-acquired AKI; and (ii) potentially medication-related AKI and patient adverse outcomes. A retrospective cohort study utilising electronic health record data of patients admitted to a tertiary hospital in Australia in 2015. Timing of medication administration was compared with timing of AKI development. AKI cases were identified using an algorithm based on serum creatinine level changes. Multilevel regression models were applied with adjustment for relevant demographic and clinical factors. Among 11 503 admissions, AKI was identified in 955 patients (8.3%) and 637 (66.7% of 955) were preceded by administration of a GFR modifier. Patients without prior AKI were 17% more likely to develop AKI after administration of these medications (adjusted odds ratio 1.17, 95% confidence interval (CI) 1.003-1.37). Older age and comorbidity with diabetes, acute myocardial infarction, peripheral vascular disease, liver cirrhosis and multiple myeloma were also significant predictors. Patients with potentially medication-related AKI were 11.69 times more likely to die in hospital (95% CI 7.84-17.43) and stayed 3.49 times longer in hospital (95% CI 3.26-3.73), compared with those without AKI. Administration of medications contributing to the reduction of GFR is associated with an increased risk of hospital-acquired AKI and worse patient outcomes. Caution is required when prescribing these medications to patients at risk of developing AKI, and monitoring patients for deterioration is needed if administered.

Toxicological and anti-hyperglycemic studies of five plants used for the treatment of type 2 diabetes in Benin

In Benin as in the African sub-region, the burden of Non-Communicable Diseases (NCDs) and the threats they represent constitute a major public health problem which hinders their economic and social development. NCDs kill 36 million people each year and 80% of deaths occur in developing countries, including Benin. The objective of our work is to evaluate the acute, subacute toxicity and the anti-hyperglycemic activity of five plants listed through an ethno pharmacological survey which is used for the treatment of type 2 diabetes in Benin. The acute toxicity test was conducted on male and female wistar rats at a single dose of 2000 mg/kg. The subacute toxicity test was carried out over a period of 28 days, with 6 batches of 3 rats. Batch 1 received daily 1 ml/100 g of distilled water and batches 2, 3, 4 and 5 respectively the leaf extracts of Bambusa vulgaris Schrad. Ex-Wendel; Parkia biglobosa (Jacq.) R. Br. Ex G. Don; Mangifera indica L.; Saccharum officinarum L.; And Annona muricata L. at a daily dose of 200mg/kg per day for 28 days. Administration of the single dose of the extract did not cause any deaths. In rats treated with repeated doses of 200mg/kg for 28 days the variation in weight depends on the extracts. The level of transaminases (AST and ALT) did not vary. Plant extracts did not induce any significant change in creatinine level. All five extracts have anti-hyperglycemic activity. Our results allow us to deduce that these plants can be used to prevent and treat diabetes without the risk of hepatic and renal toxicity.&#x0D; Keywords: Medicinal plants; Type 2 diabetes; Toxicity; efficacy

Risk Factors and Outcome of Acute Kidney Injury following Acute Myocardial Infarction-A Case Series Study from 2009 to 2019.

Background: Historically, acute kidney injury (AKI) has been a common severe complication of acute myocardial infarction (MI). As percutaneous coronary interventions have become more widely used, AMI outcomes have significantly improved. However, post-AMI AKI epidemiology and its associated factors are not well-understood in the age of interventional cardiology. Materials and methods: This is a retrospective study examining changes in creatinine levels in all patients admitted for AMI in a single medical center between August 2009 and February 2019. KDIGO criteria were used to define the different stages of post-AMI AKI. Results: The study included 1299 eligible cases, among which 213 (16.4%) developed AKI during AMI index admission; and 128 (60.1%), 46 (21.6%), and 39 (18.3%) were classified as KDIGO stages 1, 2, and 3, respectively. Compared with non-AKI subjects, the AKI group had a higher prevalence of non-STEMI (48.4% vs. 29.1%, p < 0.001), higher Killip class (3 or 4), and higher in-hospital mortality (15% vs. 2.5%, p < 0.001). During the index MI hospitalization, 13.6% (29/213) of the post-MI AKI patients received hemodialysis. Baseline abnormal creatinine (≥1.5 mg/dL), dyslipidemia, and more advanced KDIGO stages (2 or 3) were associated with an increased risk of requiring in-hospital hemodialysis. Moreover, a more advanced KDIGO stage (≥2) was correlated with higher all-cause in-hospital mortality. Conclusion: AMI patients remain at risk of AKI, which negatively affects their survival in the modern age.

Impact of Acute Blood Loss on Clinical, Hematological, Biochemical, and Oxidative Stress Variables in Sheep.

Blood loss in sheep can have different causes and may result in anemia. We aimed to evaluate the clinical, hematological, and biochemical alterations and the oxidative stress generated by acute blood loss. Eighteen healthy sheep underwent phlebotomy to remove 40% of the blood volume and were evaluated clinically and by laboratory tests for clinical, biochemical, and blood gas variables and to assess oxidative stress before induction (T0), 30 min (T30 min), and 6 (T6 h), 12 (T12 h), and 24 h (T24 h) after blood loss. The sheep showed tachycardia from T30 min until T24 h, reduction in the hematocrit, number of erythrocytes, and hemoglobin concentration, with lower values at T24 h and increase in the number of leukocytes from T12 h on. There was a reduction in blood pH and oxygen pressure at T30 min, increased lactate concentration and reduced blood bicarbonate at this time. There was an increase in urea concentration from T6 h until the end of the study, with no change in creatinine levels. The animals did not show changes in the concentration of malonaldehyde, and in the activity of the enzymes superoxide dismutase, glutathione peroxidase, and catalase, but there was a reduction in the concentration of reduced glutathione at T24 h. The acute loss of 40% of blood volume is capable of promoting relevant clinical, hematological, blood gas, and biochemical alterations, and contributed to the appearance of oxidative stress with reduced glutathione concentration, suggesting that this process generated free radicals in sufficient quantity to diminish the action of antioxidants.

Glucose, urea, and creatinine laboratory tests in people starting antiretroviral therapy with dolutegravir or efavirenz: a cohort study in Belo Horizonte, Brazil

Goal: In this study, we aimed to monitor the blood glucose, urea, and creatinine laboratory tests in treatment-naive individuals, initiating ART with an antiretroviral regimen containing EFV or DTG, searching for a contribution to the understanding of the safety of these drugs in use in the real world, followed up for 72 weeks. Methods: Cohort study with a follow-up of people living with HIV initiating antiretroviral therapy. Results: An increase in blood creatinine levels at 24 and 48 weeks and blood glucose levels at 48 weeks (p=0.017) was observed in the group using Dolutegravir. Those using Efavirenz evidenced an increase in creatinine levels at 48 weeks (p=0.007), blood glucose levels at 72 weeks (p=0.009), and urea levels at 48 weeks (p=0.023). Being male (p=0.044) and having more than 13 schooling years (0.044) explained the change in creatinine levels. Tobacco use (p=0.006), illicit drug use (p=0.009), and schooling greater than or equal to 13 study years (p=0.038) were independently associated with changes in urea levels. The therapeutic regimen with Efavirenz (OR=8.20; 95% CI=1.32-51.05; p=0.024) and schooling greater than or equal to 13 study years were independently associated with increased blood glucose concentration. Conclusions: The DTG regimen was associated with increased serum creatinine levels for up to 42 weeks and was transient and returning to the levels observed before the start of ART. The Efavirenz regimen was related to increased serum glucose levels, and the Dolutegravir therapy was the preferred regimen.

Newcastle disease virus expressing an angiogenic inhibitor exerts an enhanced therapeutic efficacy in colon cancer model.

Newcastle disease virus (NDV)-mediated gene therapy is a promising new approach for treatment of cancer but shows limited anti-angiogenesis. VEGF-Trap plays a vital role in anti-angiogenesis. To enhance the anti-tumor effect of NDV, VEGF-Trap gene was incorporated into the genome of rNDV in this study (named rNDV-VEGF-Trap). Results showed that rNDV-VEGF-Trap reduced cell growth ratio by 85.37% and migration ratio by 87.9% in EA.hy926 cells. In vivo studies, rNDV-VEGF-Trap reduced tumor volume and weight of CT26-bearing mice by more than 3 folds. Immunohistochemistry analysis of CD34 showed rNDV-VEGF-Trap significantly decreased the number of vascular endothelial cells in the tumor tissues. Moreover, Western blot analysis demonstrated that treatment with rNDV-VEGF-Trap significantly decreased the phosphorylation levels of AKT, ERK1/2 and STAT3 and increased the expression levels of P53, BAX and cleaved caspase-3 in the tumor tissue. In addition, to evaluate the toxicity of rNDV-VEGF-Trap, serum chemistries were analyzed. The results showed that rNDV-VEGF-Trap caused insignificant changes of creatinine levels, alanine aminotransferase and aspartate transaminase. Furthermore, administration of rNDV-VEGF-Trap did not cause the diarrhoea, decreased appetite, weight decrease and haemorrhage of the experimental mice. These data suggest that rNDV-VEGF-Trap exhibits an enhanced inhibition of CT26-bearing mice by enhancing anti-angiogenesis and apoptosis and may be a potential candidate for carcinoma therapy especially for colon cancer.

Effect of glucagon-like peptide-1 receptor agonists on renal function: A meta-analysis of randomized controlled trials.

The objective of this meta-analysis was to examine the impact of the GLP-1 RA on renal function parameters in randomized controlled trials. A systematic search was performed in PubMed-MEDLINE, Scopus, Web of Science, ClinicalTrials.gov, and Google Scholar databases. Meta-analysis was performed using a random-effects model and sensitivity analysis. Data from 18 randomized controlled trials involving 12 192 subjects, showed that treatment with GLP-1 RA had no effect on serum creatinine levels (weighted mean difference [WMD]: 0.00 mg/mL, 95% confidence interval [CI]: -0.01, 0.01, P = .83, I2 = 0%) and glomerular filtration rate (WMD: 1.01 mL/min/1.73 m2 , 95% CI: -1.61, 3.63, P = .45, I2 = 75%). On the other hand, a significant reduction in urinary albumin excretion (WMD: -18.01 mg/day, 95% CI: -31.20, -4.82, P = .007, I2 = 23%) and albumin-to-creatinine ratio (WMD: -6.74 mg/g, 95% CI: -12.64, -0.85, P = .03, I2 = 68%) was detected after GLP-1 RA therapy. Results of our meta-analysis revealed that GLP-1 RA treatment decreases urinary albumin excretion and albumin-to-creatinine ratio but it did not cause significant changes in creatinine levels and glomerular filtration rate.