Blood Creatinine Concentrations Research Articles

Comparability and Stability of Serum Creatinine Concentration in Capillary and Venous Blood.

Background: The use of self-collected capillary blood has several advantages over phlebotomy, as such finger-prick testing is rapidly becoming accepted as a routine sample type for adults. However, there is limited evidence that venous and capillary serum is comparable for many analytes. This study aimed to determine whether capillary samples could offer an alternative sampling method to venous samples for the assessment of serum creatinine using the enzymatic method and if this analyte was stable in unspun capillary blood for 3days. Methods: Matched capillary and venous blood samples were collected from 48 patients for the determination of serum creatinine, one set being processed on day zero, the other set being stored at ambient temperature and then processed on day three. Self-collected capillary blood was compared with phlebotomist-collected venous samples. Results: Serum creatinine concentrations from venous and capillary blood samples taken on day zero were compared to concentrations in capillary blood from day three. Data produced showed serum creatinine concentrations from capillary and venous serum to be comparable. Conclusion: It is believed that this is the first published study to determine if self-collected capillary blood sampling is an acceptable alternative to venous sampling for the measurement of serum creatinine concentration; our data indicates that there is no significant difference in results from unspun venous and capillary blood stored at room temperature for at least 3days compared to venous blood tested on the same day of collection.

Acute kidney injury is common in dogs with septic peritonitis and is associated with increased mortality.

To identify the frequency of and risk factors for acute kidney injury (AKI) in dogs undergoing abdominal surgery for septic peritonitis, and to evaluate outcome and kidney-related risk factors for survival to discharge in those dogs. 77 dogs that underwent abdominal surgery for septic peritonitis. Medical records of dogs that underwent surgery for septic peritonitis from 2012 through 2022 were reviewed. Data regarding signalment, clinical and biochemical findings at presentation, blood creatinine concentration throughout hospitalization, surgery characteristics, postoperative monitoring, and outcome were collected. Dogs were classified based on occurrence of AKI and whether they presented with or developed AKI in-hospital. Perioperative risk factors were evaluated, and outcomes were compared with univariable logistic regression. 31 dogs (40.3%) had AKI diagnosed; 18/77 (23.4%) dogs presented with AKI, 11 (61.1%) of which had it postoperatively, and 13/77 (16.9%) dogs developed AKI postoperatively. Significant factors for presenting with AKI included increasing baseline respiratory rate (OR 2.5 for every 10 beats per minute higher), decreasing systolic blood pressure (OR 0.8 for every 10 mm Hg higher), and increasing body condition score (OR 2.2 for every score greater). No significant factors for developing AKI postoperatively were identified after multiple comparisons adjustment. Sixteen dogs (20.8%) did not survive to discharge; 12 (75.0%) had AKI and 4 (25.0%) did not. Dogs with AKI had decreased odds of survival to discharge (OR 0.2). AKI was common in dogs with septic peritonitis and was a significant risk factor for survival to discharge. Clinical surveillance of AKI is critical in this population.

AACC/NKF Guidance Document on Improving Equity in Chronic Kidney Disease Care.

Kidney disease (KD) is an important health equity issue with Black, Hispanic, and socioeconomically disadvantaged individuals experiencing a disproportionate disease burden. Prior to 2021, the commonly used estimated glomerular filtration rate (eGFR) equations incorporated coefficients for Black race that conferred higher GFR estimates for Black individuals compared to non-Black individuals of the same sex, age, and blood creatinine concentration. With a recognition that race does not delineate distinct biological categories, a joint task force of the National Kidney Foundation and the American Society of Nephrology recommended the adoption of the CKD-EPI 2021 race-agnostic equations. This document provides guidance on implementation of the CKD-EPI 2021 equations. It describes recommendations for KD biomarker testing, and opportunities for collaboration between clinical laboratories and providers to improve KD detection in high-risk populations. Further, the document provides guidance on the use of cystatin C, and eGFR reporting and interpretation in gender-diverse populations. Implementation of the CKD-EPI 2021 eGFR equations represents progress toward health equity in the management of KD. Ongoing efforts by multidisciplinary teams, including clinical laboratorians, should focus on improved disease detection in clinically and socially high-risk populations. Routine use of cystatin C is recommended to improve the accuracy of eGFR, particularly in patients whose blood creatinine concentrations are confounded by processes other than glomerular filtration. When managing gender-diverse individuals, eGFR should be calculated and reported with both male and female coefficients. Gender-diverse individuals can benefit from a more holistic management approach, particularly at important clinical decision points.

Extravesicular, two-layer, side-to-side ureteroneocystostomy combined with tension-relieving techniques for feline proximal ureteral obstruction: A retrospective study.

To describe the surgical technique for extravesicular, two-layer, side-to-side ureteroneocystostomy combined with tension-relieving techniques (ETSUTT) for feline proximal ureteral obstruction and report clinical outcomes. Retrospective case series. Ten privately-owned cats with ureteral obstruction near the ureteropelvic junction (UPJ). Medical records were retrospectively reviewed for cats with ureteral obstruction close to the UPJ that underwent ETSUTT (2018-2021). The ETSUTT procedure consisted of a modified extravesicular technique (two-layer, side-to-side ureteroneocystostomy) and tension-relieving techniques (renal descensus, ureterocystopexy, and nephrocystopexy). All cats survived through discharge. In all cats, postoperative blood urea nitrogen and creatinine concentrations were decreased, compared with preoperative concentrations. Perioperative complications included ureteral catheter dislodgement (3), transient pollakiuria (2), and dysuria (1), but no specific treatments were required. Urinary tract infection was observed postoperatively in three of the 10 cats. The median follow-up was 648 days (min-max: 86-1229 days). Seven of the 10 cats were alive without recurrent ureteral obstruction at the end of this retrospective study. The ETSUTT procedure was successfully performed without major complications in cats with ureteral obstruction occurring near the UPJ. Use of ETSUTT provided a fair-to-good, long-term prognosis in cats that were otherwise difficult to manage. This novel procedure, ETSUTT, was feasible, safe, and could be a viable treatment option for feline proximal ureteral obstruction, including the UPJ, especially for obstructions caused by stricture.

600-P: Higher Hydration Status Is Indicative of Better Glucose Tolerance

Introduction: Water intake is an important dietary behavior to replace high-caloric beverages and to enhance metabolic health. Type 2 diabetes is a metabolic disorder that has been shown to be more prevalent in Hispanics, a population shown to consume relatively less water compared to non-Hispanic Whites. The underlying cause of type 2 diabetes is insulin resistance, characterized by hyperglycemia and impaired glycemic control. However, whether a relationship exists between dehydration and the development of diabetes remains to be elucidated. Purpose: To evaluate if hydration status indicates glucose tolerance among a dominant Mexican American population. Methods: Sixty-one participants without diabetes (Age: 26.5 ± 9.1 years; BMI: 27.5 ± 6.0 kg/m2) participated in the study. Fasting blood glucose level was determined, and a 2-hour glucose tolerance test was performed following the ingestion of a 75g glucose drink. Blood glucose concentration levels were determined at 15−, 30−, 60−, 90−, and 120-minute time intervals post ingestion and glucose area under the curve was analyzed as well. Blood works were performed to determine blood urea nitrogen (BUN) and creatinine concentrations. Hydration status was estimated using the ratio of BUN to creatinine values. Results: Hydration status measured by BUN/Creatinine was positively associated with glucose intolerance measured at 15−, 30−, 60−, and 90-minute post glucose load and by glucose area under the curve (r=0.33; r=0.43; r=0.37; r=0.27; and r=0.41 respectively; p<0.05). Conclusion: Adequate fluid consumption should be encouraged for glycemic control, especially among people with high diabetes risks. Disclosure J.Apaflo: None. J.Labadah: None. G.Narvaez: None. V.M.Rocha: None. A.Mossayebi: None. S.Bajpeyi: None.

#5423 THE FUNCTIONAL STATE OF THE KIDNEYS IN PATIENTS WITH CHRONIC ISCHEMIA OF THE RENAL AND PERIPHERAL ARTERIES

Abstract Background and Aims to study the functional state of the kidneys in patients with chronic ischemia of the renal and peripheral arteries. Methods We examined 120 patients with chronic lower limb ischemia (CLLI) on the background of coronary heart disease and type 2 diabetes mellitus. All examined patients were hospitalized in the department of Interventional Cardiology of the Republican Specialized Scientific and Practical Medical Center for Therapy and Medical Rehabilitation. Inclusion criteria for the study was the presence of intermittent claudication in the patient of II A-II B degree of CLLI, while the walking distance without pain in these patients was 50-1000 meters. Assessment of the functional state of the kidneys was carried out on the basis of determining the level of serum creatinine (Cr), glomerular filtration rate (GFR), calculated according to the EPI GFR formula, which takes into account race, gender, age, and serum creatinine level. To calculate GFR using the CKD-EPI formula, can be used special applications for mobile devices (QxMDCalculator) (based on the criteria of the clinical guidelines for the diagnosis, classification and treatment of CKD KDIGO - 2013). Results Analysis of the functional state of the kidneys depending on the severity of CKD and the level of GFR in accordance with the KDIGO classification (2013) showed that all 100% of patients with CLLI belonged to CKD categories: CKD C2 - 62 (51.7%), CKD with 3a-b - 51 (42.5%) and CKD with 4 - 7 (5.83%). In other words, there was not a single patient with CLLI with normal GFR values. We have revealed a significant increase in the concentration of blood creatinine by 2.1 times, blood urea by 77.9%, and a decrease in GFR by 64.3% (p<0.001). The mean value of the concentration of total protein in the blood serum was 58.4±3.72 mmol/l. The concentration of urea in the blood serum was 12.1±2.47 mmol/l in the CLLI group versus 6.8±0.33 mmol /l in the control group. The parameters of the functional state of the kidneys depending on the severity of CLLI showed that in the group of patients with stage IIB was an increase in serum creatinine clearance by 47.2%, amounting to 179.2 ± 15.5 μmol / l versus the data of IIA 121, 2±13.3 µmol/l (p<0.01). There was also a decrease in the level of GFR in patients with stage IIB by 29.1% (p<0.01) in relation to the data of stage IIA. Conclusion In all patients with CLLI, there was deterioration in the functional state of the kidneys, which was manifested by an increase in the concentration of blood creatinine, a decrease in GFR and the severity of albuminuria.

Blood biochemical parameters in mice under the action of polyphosphate esters and their complexes with antibiotics

Complexes of polyphosphate esters with antibiotics were developed in Lviv Polytechnic National University together with scientists of Institute of Animal Biology NAAS to reduce the negative impact of antibiotics on the animal body. The conducted experiments allow assessing the effect of antibiotics, polyphosphate esters and complexes of polyphosphate esters with antibiotics on the body of laboratory animals based on biochemical markers of hepato- and nephrotoxicity. The antibiotics were administered in average daily therapeutic doses. It was found that the physiological state of mice and their blood biochemical indicators were within physiological normal values after the administration of polyphosphate ester P4 and complexes of polyphosphate ester P4+antibiotics (amoxicillin, oxytetracycline, and doxycycline). At the same time, intramuscular administration of polyphosphate ester P6 and complexes of P6+antibiotics have a certain negative effect on mice, which is manifested by changes in the activity of marker enzymes: aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP). We found an increase in AST and ALT activities. P6+amoxicillin and P6+oxytetracycline complexes increased ALP activity. Complexes P4+antibiotics decreased ALP. Blood urea content decreased after the administration of polyphosphate ester P6 by 38.5%, P6+oxytetracycline by 26.9%, P6+doxycillin by 21.8%. P6+amoxicillin complex caused a significant increase by 237% in the concentration of creatinine in the blood of mice. The changes of blood creatinine concentration of other experimental groups fell within normal physiological range. Conducted studies of blood biochemical characteristics of mice under the action of new complexes of nanobiopolymer transporters with antibiotics ensured the selection of antibacterial drugs with low toxicity.

Development and evaluation of an electrochemical biosensor for creatinine quantification in a drop of whole human blood

An electrochemical biosensor for creatinine determination in a drop of whole human blood was developed and applied to the determination of creatinine in real clinical samples. It is based on the modification of a dual carbon working electrode with a combination of three enzymes: creatinine amidohydrolase (CNN), creatine amidinohydrolase (CRN) and sarcosine oxidase (SOX). Electrochemical transduction is performed using horseradish peroxidase (HRP) and potassium hexacyanoferrate(II) as mediator. A drop of human blood is enough to carry out the measurements by differential chronoamperometry where one carbon electrode detects creatine and the other both creatine and creatinine. The integrated differential signal obtained in the biosensor is linear with the concentration of creatinine in blood in the range 0.5–15 mg/dL and the enzyme-modified electrodes are stable for at least 3 months at 4 °C. The biosensor was lined to a reference method based on Isotope Dilution Mass Spectrometry (IDMS) with 50 real human blood samples and the results compared with those obtained by alternative routine techniques based on Jaffé method and an enzymatic method (Cobas 8000 Roche®, Crep2 Roche®). There were no significant differences between the creatinine concentrations found by the routine techniques and the developed biosensor.

Prognostic value of serum cystatin C concentration in dogs with myxomatous mitral valve disease.

Impaired renal function is 1 of the poor prognostic factors in dogs with myxomatous mitral valve disease (MMVD). However, the value of cystatin C (Cys-C), a marker of renal function, as a prognostic marker for MMVD in dogs has not yet been explored. This study aims to investigate the prognostic value of Cys-C in dogs with MMVD. Fifty client-owned small-breed dogs with MMVD were included in this study. This is a retrospective, cross-sectional study. The prognostic value of serum Cys-C concentration was assessed using univariable and multivariable Cox hazard regression analyses. Kaplan-Meier survival curves for MMVD-specific survival in dogs stratified into high and low Cys-C groups were generated and analyzed using the log-rank test. Serum Cys-C concentrations were significantly associated with MMVD-related death (P < .01) in both univariable (hazard ratio [HR], 5.086; 95% confidence interval [CI], 1.950-13.270) and multivariable Cox hazard regression analysis (HR, 4.657; 95% CI, 1.767-12.270). The high Cys-C group (n=14) had a significantly shorter MMVD-specific survival time than the low Cys-C group (n=36; P < .01). In dogs with normal blood creatinine concentrations, the high Cys-C group (n=10) had a significantly shorter MMVD-specific survival time than the low Cys-C group (n=36; P < .01). High serum Cys-C concentrations were associated with a worse prognosis of MMVD. Furthermore, serum Cys-C could be a predictor of MMVD prognosis even in dogs with normal blood creatinineconcentration.

Влияние пероксиредоксина 6 на нефроны в ранний реперфузионный период после ренальной ишемии у крыс

Renal reperfusion injury develops rapidly after ischemia relief. It is with the onset of reperfusion that a cascade of pathological processes is launched, which means that measures to protect the kidney have to be taken as early as in this period. The aim of the paper was to study the effect of exogenous peroxiredoxin 6 (Prx6) on the morphofunctional state of nephrons in the initial reperfusion period following ischemia. Materials and methods. The right kidney of rats was subjected to 45-minute ischemia with prior left-sided nephrectomy and examined after 2, 5 and 24 hours of reperfusion. Exogenous Prx6 was administered intravenously 15 minutes before ischemia. Results. The research showed that nephrectomy has no effect on the morphology of a single kidney, but leads to an increase in urea and creatinine in the blood within 24 hours. We noted signs of morphological and functional damage to nephrons after 2 hours of reperfusion, which tend to increase in the course of 24 hours. In addition, we observed a rise in blood creatinine and urea concentrations, an increase in the areas of renal corpuscles, glomeruli, and Bowman’s capsule, as well as dystrophic changes in nephrocytes and an increase in the immunosignal area of the kidney injury molecule-1 (KIM-1). When exogenous Prx6 was used, we observed normalization of the size of nephron components, a decrease in KIM-1 immunosignal and an improvement in the kidney’s excretory function both in the early reperfusion period and after 24 hours. Thus, exogenous Prx6 reduces damage to nephrons during the early reperfusion period, which improves their compensatory and adaptive properties in ischemia-reperfusion injury.

The comparison between different over-the-counter drugs Analgesics used to relive cramps pain associated with menstrual cycle for females in Jordan on kidney function

Primary dysmenorrhea is an abdomen cramps caused pain for females under menstrual cycle. The majority of females in Jordan are consuming paracetamol and different types of NSAIDs to relive the mentioned pain. In this study a different group of females between ages 18–24 years old either not consuming any analgesic or consuming paracetamol, ibuprofen, or diclofenac salts have been asked to test the blood creatinine concentration after 10 days of consumption and after 5 and 10 days of discontinuation. SPSS analysis technique was used to analyse the results. As a results, consuming of paracetamol for 10 days show similar creatinine clearance for females without consuming any type of analgesics. While ibuprofen and diclofenac salts show change in kidney function after the 10 days of consumption. Ibuprofen normal kidney function was for 94.1% of the females where only 0.9% of the females show a sign of acute renal failure. On the other hand, the females using diclofenac salts show a high percentage of 61.2% with a sign of acute renal failure. Most of females show restored renal function after discontinuation of analgesics for 5 or 10 days. In conclusion, the consumption of analgesics between females should be monitored while the using of diclofenac salts should be considered as a prescribed drug due to the major and serious adverse drug reactions caused by the daily consumption.

Peritoneal equilibration testing: Your questions answered.

The peritoneal equilibration test (PET), first described in 1987, is a semiquantitative assessment of peritoneal transfer characteristics in patients undergoing peritoneal dialysis. It is typically performed as a 4-h exchange using 2.27/2.5% dextrose dialysate with serial measurements of blood and dialysate creatinine, urea, and glucose concentrations. The percentage absorption of glucose and D/P creatinine ratio are used to determine peritoneal solute transfer rates. It is used to both help guide peritoneal dialysis prescriptions and to prognosticate. There are several derivative tests which have been described in the literature. In this review, we describe the original PET, the various iterations of the PET, the information gleaned, and the use in the setting of poor solute clearance and in the diagnosis of membrane dysfunction, and limitations of the PET.

Carduus edelbergii Rech. f. Mediated Fabrication of Gold Nanoparticles; Characterization and Evaluation of Antimicrobial, Antioxidant and Antidiabetic Potency of the Synthesized AuNPs.

Background: Due to the high expense, less effectiveness and more side effects of available synthetic medicine, the researchers and communities are focusing on phyto-based natural bioactive compounds, which are considered safer for the treatment of syndromes and chronic diseases. Aim: The current project was aimed to determine the phytochemicals constituents available in the aerial parts of methanol extract of Carduus edelbergii via GC-MS, fabrication of AuNPs mediated with the mentioned extract; characterization and evaluation of antimicrobial, antioxidant and antidiabetic potency of the synthesized AuNPs. Methods: Confirmation of green synthesis of AuNPs, functional groups responsible for the reduction in Au+, size and crystallinity, morphology and quantity of gold (Au) were carried out by Ultraviolet-Visible (UV-Vis) spectroscopy, Transform Infrared (FTIR) spectroscopy, Scanning Electron Microscopy (SEM), X-ray Diffraction (XRD) and dispersive X-ray (EDX), respectively, whereas in vitro antioxidant characteristics were assessed by DPPH and ABTS assays. Wistar albino rats were used to test the anti-diabetic properties of the methanol extract and AuNPs. Results: GC-MS revealed that the diluted methanol extract of Carduus edelbergii consists of about 19 chemical constituents. Among the identified compounds, the 13-Docosenoic acid, methyl ester, (Z)—has the highest concentration (38.16%), followed by 9-Octadecenoic acid, methyl ester, (E)—(15.72%) and n-Hexadecanoic acid (15.07%). Methanol extract and its fabricated nanoparticles showed significant antioxidant and antimicrobial activities. In vivo antidiabetic study revealed a noteworthy (p < 0.05) decline in body weight and HDL and elevated concentration of blood glucose, bilirubin, creatinine, urea, triglyceride, VLDL, LDL, ALP, ALT and AST in diabetic control. The said changes were recovered significantly (p < 0.05) by treatment of diabetic rats with methanol extract (150 and 300 mg/Kg BW) and AuNPs of Carduus edelbergii (5 and 10 mg/Kg BW). Conclusion: The green synthesized AuNPs exhibit significant antioxidant, antimicrobial and antidiabetic characteristics.

308 Evaluation of Implants and Precision Supplementation on Growth and Muscle Accretion in Beef Steers Post Weaning

Abstract Backgrounding or stocker operations attempt to add value to calves by efficiently adding weight and predominately taking advantage of the protein accretion phase of development, ultimately preparing calves for later stages of production. The objective of the current study was to evaluate the effects of an implant (Revalor-G) or implant plus supplementation on protein accretion patterns in backgrounded beef steers. A 56-day backgrounding study was conducted using Angus-based steers (n = 69; initial BW 233 ± 29 kg) grazing a cow pea and millet mixture. Steers were randomly assigned to one of three treatments (n = 23 steers per treatment): 1) grazing only (G), 2) grazing with implant (GI), or 3) grazing with implant plus individual animal supplementation via Super Smart Feeder at 0.75% BW (GIS). Steers were weighed and blood was collected every 14 days to determine plasma blood urea nitrogen (BUN) and creatinine concentrations. Ultrasound measurements of ribeye area and backfat were collected at days 0, 28, and 56 of study. Data were analyzed using the GLIMMIX function of SAS version 9.4. GIS steers had a greater (P ≤ 0.0004) body weight change than GI or G steers. GI and GIS steers had a greater (P ≤ 0.0117) ribeye area compared with G steers. GI steers had a greater (P &amp;lt; 0.0180) ribeye area to body weight ratio than G steers. When evaluating blood parameters, GI steers had a greater (P&amp;lt; 0.0009) plasma BUN concentration than GIS steers. No treatment differences were observed for plasma creatinine concentrations. G and GI steers had a greater (P ≤ 0.0290) BUN to creatinine ratio than GIS steers. Results of this study suggest that implanted steers may require additional supplementation to optimize growth and muscle accretion.

Comparison of 24‐hour urinary creatinine clearance and estimated glomerular filtration rate based on a panel of filtration markers in patients with chronic kidney disease

Diagnosis and management of chronic kidney disease (CKD) requires accurate assessment of glomerular filtration rate (GFR). In practice, GFR is typically estimated by equations based on creatinine concentration in blood, but creatinine is affected by non‐GFR factors such as age and sex. Alternative filtration markers such as cystatin C, beta‐trace protein (BTP), and beta‐2 microglobulin (B2M) may be less dependent on age and sex, but equations combining these markers have not been investigated in patients with chronic kidney disease (CKD). In this cross‐sectional study of 50 patients with CKD stage 3–4, we compared kidney function estimates based on creatinine, cystatin C, BTP, B2M, or a combination of markers. Compared to the creatinine/cystatin C combination equation, the panel equation yielded a mean difference of only 2.8 ml/min/1.73 m2, indicating that switching to the panel equation would be unlikely to affect management.

Anamnestic and biochemical predictors of obstetric and perinatal complications in intrahepatic cholestasis of pregnancy

Objective. To determine the anamnestic and biochemical predictors of obstetric and perinatal complications in women with intrahepatic cholestasis of pregnancy (ICP).Materials and methods. 59 women with ICP and 30 pregnant women included into the comparison group were examined. The characteristics of the reproductive history, anamnesis of the disease, complaints, biochemical parameters of liver function (syndromes of cholestasis and hepatocyte cytolysis, function of protein synthesis), features of the course and treatment of ICP were studied.Results. The main predictors of preterm birth in the women with ICP were: age (P(U)=0.027), multiple pregnancy (OR=17.5, p=0.033); alkaline phosphatase (ALP) blood level &gt; 499 U/l (AUC=0.801; p=0.008); De Ritis Ratio value ≤ 0.49 (AUC=0.757; p=0.005). The main prognostic markers for meconium staining of amniotic fluid (MSAF) in the patients with ICP were: ICP in previous pregnancies (OR=7.1; p=0.029); serum bile acid concentration &gt; 14 μmol/l (AUC=0.718; p=0.043); total bilirubin blood level &gt; 13 μmol/l (AUC=0.773; p=0.007); ALP activity &gt; 484 U/l (AUC=0.728; p=0.033); blood creatinine concentration ≤ 60 μmol/l (AUC=0.930; p=0.0001) in asymptomatic course. The development of respiratory disorders in children born to women with asymptomatic ICP was associated with a total protein concentration in the blood of 78 g/l or less (AUC=0.852; p=0.0001).Conclusion. The anamnesis of the disease and the determination of the levels of the biochemical parameters of liver function allows predicting obstetric and perinatal complications in ICP.

Failure to Rescue After Severe Acute Kidney Injury in Patients Undergoing Non–Cardiac Surgery

IntroductionMany deaths after surgery can be attributed to “failure to rescue,” which may be a better surgical quality indicator than the occurrence of a postoperative complication. Acute kidney injury (AKI) is one such postoperative complication associated with high mortality. The purpose of this study is to identify perioperative risk factors associated with failure to rescue among patients who develop postoperative AKI. MethodsWe identified adult patients who underwent non–cardiac surgery between 2012 and 2018 and experienced postoperative severe AKI (an increase in blood creatinine concentration of >2 mg/dL above baseline or requiring hemodialysis) from the American College of Surgeons National Surgical Quality Improvement Program database. Multivariable logistic regression was used to identify risk factors for failure to rescue among patients who developed severe AKI. ResultsAmong 5,765,904 patients who met inclusion criteria, 26,705 (0.46%) patients developed postoperative severe AKI, of which 6834 (25.6%) experienced failure to rescue. Risk factors with the strongest association (adjusted odds ratio >1.5) with failure to rescue in patients with AKI included advanced age, higher American Society of Anesthesiologists class, presence of preoperative ascites, disseminated cancer, septic shock, and blood transfusion within 72 h of surgery start time. ConclusionsAbout one-fourth of patients who develop severe AKI after non–cardiac surgery die within 30 d of surgery. Both patient- and surgery-related risk factors are associated with this failure to rescue. Further studies are needed to identify early and effective interventions in high-risk patients who develop postoperative severe AKI to prevent the antecedent mortality.

Anti-hangover and Anti-gout Effects of Asparagus Byproduct Extracts

Background: Given the reported pharmacological effects of rutin from asparagus stems and roots, here, we assessed the anti-hangover and anti-gout effects of asparagus stem and root extracts.<BR>Methods and Results: We found that rutin amount in ethanol extracts of asparagus stems was 10.15 ㎎/g, and in hydrothermal extracts of asparagus roots it was 3.28 ㎎/g. Alcohol dehydrogenase and aldehyde dehydrogenase activities in asparagus-stem extracts were 80% and 40% of those in the control group, respectively. Following hangover induction in rats using alcohol, an injection of 400 ㎎/㎏ body weight (BW) of the extract significantly reduced the blood alcohol concentration compared to that of the control group. Additionally, blood gamma-glutamyl transpeptidase (GGT), glutamic oxaloacetic transaminase (GOT), and glutamic pyruvic transaminase (GPT) concentrations measured 5 h after alcohol administration revealed that treatment with 400 ㎎/㎏ BW of extract significantly reduced GGT and GOT concentrations compared to the control group, whereas changes in GPT were not significant. Moreover, xanthine oxidase activity after treatment with hydrothermal extracts of asparagus roots was 44.01 ± 0.32%, showing 53.3% inhibition compared to the positive control (allopurinol; 82.50 ± 4.98%). To assess the anti-gout effect of hydrothermal extracts of asparagus roots, we induced gout in rats by intraperitoneal injection of potassium oxonate and measured blood uric acid, creatinine, and blood urea nitrogen concentrations at 3 h post-administration of the extract. The results showed a significant reduction in creatinine and uric acid levels in the treated group compared to the control.<BR>Conclusions: These findings demonstrated the potential of asparagus stem and root extracts as functional ingredients.

ВЗАИМОСВЯЗЬ ОБМЕНА ФОСФАТОВ И ФУНКЦИИ ВНЕШНЕГО ДЫХАНИЯ У ДЕТЕЙ И ПОДРОСТКОВ С БРОНХИАЛЬНОЙ АСТМОЙ

Objective of the study: to study some indicators of renal function, phosphate homeostasis and their relationship with external respiration function parameters in children and adolescents with bronchial asthma (BA). Materials and methods of research: a pilot prospective non-randomized single-center comparative study of 31 children aged 12.0 [9.0; 14.0] years with atopic BA. All children underwent anthropometry, spirometry, blood biochemical parameters test and 24-hour urine collection. Results: glomerular filtration rate calculated by the classic Schwartz formula was below the median in 18 (58%) of 31 patients. Serum phosphate concentration was excessive (more than +1Z above the mean) in 71% (22/31) of patients. Positive relationships were found between the maximum expiratory flow rate at the 25% point of the flow–volume loop (MOC25), the average expiratory flow rate at the 25–75% portion of the flow–volume loop (COC25–75), and blood creatinine concentration (r=0.36, p=0.04 and r=0.34, p=0.05, respectively); a negative relationship between the ratio of forced expiratory volume in 1 s to forced vital capacity and urinary phosphate concentration (r=–0.38, p=0.03). A negative relationship was noted between MOC25, SOC25–75 and urinary phosphate concentration (r=–0.37, p=0.03 and r=–0.36, p=0.04, respectively) and phosphorus/creatinine ratio (r=–0.4, p=0.02 and r=–0.39, p=0.02, respectively). Agedependent sex differences normalized phosphate excretion was positively correlated with MOC25 (r=0.36, p=0.04). Conclusion: we have found a negative relationship between the concentration of phosphates in urine and blood with indicators of bronchial patency, as well as a positive relationship between patency in the small bronchi and the concentration of blood creatinine. The development of phosphate metabolism disorders in patients with BA may be associated with prolonged spasm of bronchial smooth muscles with the development of hyperphosphatemia and compensatory hyperphosphaturia. Further study of glomerular and tubular function in children with BA is required for the purpose of early prevention of the development of chronic kidney disease in this cohort.

Blood concentration of symmetric dimethylarginine correlates with kidney damage as assessed with a proposed histologic grading system for chronic kidney disease in tigers (Panthera tigris).

To determine the utility of blood symmetric dimethylarginine (SDMA) concentration measurement as a diagnostic tool for chronic kidney disease (CKD) in tigers (Panthera tigris) by comparing results for SDMA with those for traditional renal biomarkers and investigating correlations between these biomarkers and histopathologic kidney changes in tigers with CKD. Blood, urine, and kidney samples from 35 tigers with CKD from 2 sanctuaries. Blood (serum or plasma) and urine samples were collected antemortem. Necropsy, including gross and histologic assessment, was performed for tigers that died or were euthanized for quality-of-life reasons. Results for CKD biomarkers in blood (BUN, creatinine, phosphorus, and SDMA concentrations) and urine (protein concentration, urine protein-to-creatinine ratio, and urine specific gravity) were evaluated for correlation with histologic kidney damage scored with an objective grading scale defined by percentage of inflammation, fibrosis, and tubular atrophy. Symmetric dimethylarginine had the strongest significant correlation (ρ = 0.667) with histologic kidney damage score, followed by urine specific gravity (ρ = -0.639), blood creatinine concentration (ρ = 0.624), and BUN (ρ = 0.588). No significant correlation with kidney score was identified for blood phosphorus concentration, urine protein concentration, or the urine protein-to-creatinine ratio. We recommend SDMA be prioritized as a renal biomarker in tigers, with SDMA results considered in addition to those of other traditional renal biomarkers when assessing kidney function in tigers. Additionally, the grading scale we developed could be replicated across patients and pathologists for more consistent postmortem assessment of CKD in tigers.