Daily Urine Output Research Articles

Association of Renal Stress/Damage and Filtration Biomarkers with Subsequent AKI during Hospitalization among Patients Presenting to the Emergency Department.

Emergency departments (EDs) have a growing role in hospital admissions, but few studies address AKI biomarkers in the ED. Patients admitted to the internal medicine service were enrolled during initial workup in the ED at Robert-Bosch-Hospital, Stuttgart, Germany. Daily serum creatinine (sCr) and urine output (UO) were recorded for AKI classification by Kidney Disease Improving Global Outcomes (KDIGO) criteria. Cystatin C, kidney injury molecule-1, liver-type fatty acid-binding protein, and neutrophil gelatinase-associated lipocalin were measured in blood and urine, and IL-18, insulin-like growth factor-binding protein 7 (IGFBP7), tissue inhibitor of metalloproteinases-2 (TIMP-2) and [TIMP-2]⋅[IGFBP7] were measured in urine collected at enrollment, after 6 hours, and the following morning. Association between these biomarkers and the end point of moderate-severe AKI (KDIGO stage 2-3) occurring within 12 hours of each sample collection was examined using generalized estimating equation logistic regression. Performance for prediction of the AKI end point using two previously validated [TIMP-2]-[IGFBP7] cutoffs was also tested. Of 400 enrolled patients, 298 had sufficient sCr and UO data for classification by KDIGO AKI criteria: AKI stage 2 developed in 37 patients and AKI stage 3 in nine patients. All urinary biomarkers, sCr, and plasma cystatin C had statistically significant (P<0.05) odds ratios (ORs) for the AKI end point. In a multivariable model of the urine biomarkers and sCr, only [TIMP-2]⋅[IGFBP7] and sCr had statistically significant ORs. Compared with [TIMP-2]⋅[IGFBP7]<0.3 (ng/ml)(2)/1000, values between 0.3 and 2.0 (ng/ml)(2)/1000 indicated 2.5 (95% confidence interval [95% CI], 1.1 to 5.2) times the odds for the AKI end point and values >2.0 (ng/ml)(2)/1000 indicated 11.0 (95% CI, 4.4 to 26.9) times the odds. Addition of [TIMP-2]⋅[IGFBP7] to a clinical model significantly improved area under the receiver-operating characteristic curve from 0.67 (95% CI, 0.61 to 0.78) to 0.77 (95% CI, 0.72 to 0.86) (P<0.001); however, including both markers in the model was not significantly different from including either marker alone. Urinary [TIMP-2]⋅[IGFBP7] with pre-established cutoffs provides valuable information about risk for imminent AKI in the ED that is complementary to sCr and clinical risk factors.

Deficiency of antidiuretic hormone: a rare cause of massive polyuria after kidney transplantation.

A 15-year-old boy, who was diagnosed with Alport syndrome and end-stage renal disease, received a renal transplant from a living-related donor. On postoperative day 1, his daily urine output was 10,000 mL despite normal graft function. His laboratory findings including urine, serum osmolality, and antidiuretic hormone levels showed signs similar to central diabetes insipidus, so he was administered desmopressin acetate nasal spray. After administering the desmopressin, urine specific gravity and osmolality increased abruptly, and daily urine output declined to the normal range. The desmopressin acetate was tapered gradually and discontinued 3 months later. Graft function was good, and urine output was maintained within the normal range without desmopressin 20 months after the transplantation. We present a case of a massive polyuria due to transient deficiency of antidiuretic hormone with the necessity of desmopressin therapy immediately after kidney transplantation in a pediatric patient.

Acute kidney injury after cardiac arrest.

IntroductionThe aim of this study was to evaluate the incidence and determinants of AKI in a large cohort of cardiac arrest patients.MethodsWe reviewed all patients admitted, for at least 48 hours, to our Dept. of Intensive Care after CA between January 2008 and October 2012. AKI was defined as oligo-anuria (daily urine output <0.5 ml/kg/h) and/or an increase in serum creatinine (≥0.3 mg/dl from admission value within 48 hours or a 1.5 time from baseline level). Demographics, comorbidities, CA details, and ICU interventions were recorded. Neurological outcome was assessed at 3 months using the Cerebral Performance Category scale (CPC 1–2 = favorable outcome; 3–5 = poor outcome).ResultsA total of 199 patients were included, 85 (43%) of whom developed AKI during the ICU stay. Independent predictors of AKI development were older age, chronic renal disease, higher dose of epinephrine, in-hospital CA, presence of shock during the ICU stay, a low creatinine clearance (CrCl) on admission and a high cumulative fluid balance at 48 hours. Patients with AKI had higher hospital mortality (55/85 vs. 57/114, p = 0.04), but AKI was not an independent predictor of poor 3-month neurological outcome.ConclusionsAKI occurred in more than 40% of patients after CA. These patients had more severe hemodynamic impairment and needed more aggressive ICU therapy; however the development of AKI did not influence neurological recovery.

Abstract 10772: Could Tolvaptan Protect Renal Function in the Early Postoperative Period After Cardiac Surgery?

Introduction: Tolvaptan (TV), a vasopressin V2 inhibitor, has a strong diuretic effect, which is beneficial for body fluid management in patients with acute heart failure (AHF). Several studies have reported that TV significantly reduces worsening renal function (WRF), which has recently been highlighted as an exacerbation factor in the treatment of AHF. We hypothesized that concomitant administration of TV with conventional diuretic treatment is beneficial for perioperative body fluid management in patients who have undergone cardiac surgery. In this study, we prospectively randomized the patients into the TV group, in which TV was administered in addition to conventional diuretics, and the control group, in which the patients received conventional diuretics only. Methods: A total of 176 patients who underwent cardiac surgery were divided into 2 groups, which were the TV group (TV + furosemide, 90 patients) and conventional diuretic treatment group (Control [C], furosemide with or without spironolactone, 86 patients). We compared urine output for 3 days after surgery, the time required to restore the preoperative body weight, and the incidence of WRF between the 2 groups. In the TV group, patients received TV 7.5mg/day orally starting on POD1 and continued to take TV up to POD 5. WRF was defined as a rise in the serum creatinine level (Cr) of ≥0.3 mg/dL. Results: The mean daily urine output from POD1 to POD 3 of the TV group (2672 ± 769 mL/day) was higher than that of the C group (2240 ± 529 mL/day) (p = 0.001). The time required to restore preoperative body weight was shorter in the TV group (3.8 ± 1.4 days) than in the C group (4.8 ± 2.0 days) (p=0.003). While the highest postoperative Cr of the TV group (1.01 ± 0.50 mg/dL) was the same as that of the C group (1.16 ± 0.91 mg/dL) (p=0.25), the incidence of WRF in the TV group (9 patients, 10%) was significantly lower than in the C group (24 patients, 28%) (p=0.007), which might indicate the protective effect of TV against WRF in the patients undergoing cardiac surgery. Conclusions: Administration of TV with conventional diuretics in the early postoperative period after cardiac surgery could be beneficial in maintaining urine output without affecting renal function, which may help to avoid WRF after cardiac surgery.

Satisfactory Usage of a Lacerated Kidney for Transplantation: A Case Report

BackgroundOrgan shortage is the main bottleneck in the wait-list for transplantation; therefore, expanding the donor pool is an effective way to solve the problem. Usage of the traumatized liver for transplantation has been applied, but the use of lacerated kidneys for transplant donor is rarely reported. MethodsWe reported a successful case of donation after brain death. The donor committed suicide by jumping from a campus dormitory building. One of the donated kidneys was severely injured. Two lacerations measured 4 × 1 × 1 cm in the medial margin of the graft and 1 × 1 × 1.5 cm in the front side of the graft, respectively. After repair with continuous absorbable suture, the lacerated kidney was transplanted to a recipient. ResultsThe post-transplantation renal function gradually recovered. Furthermore, serious complications, such as large amounts of hemorrhage, delayed graft function, or urinary fistula did not occur. The serum creatinine dropped from 1232 μmol/L to 120 μmol/L and maintained normal range after surgery. In addition, the daily urine output was normal. At day 12 after operation, the patient was discharged. ConclusionsOur case shows that the use of a lacerated donor kidney appears to be feasible, but long-term effects need further observation.

Risk factors for loss of residual renal function in children treated with chronic peritoneal dialysis

In dialyzed patients, preservation of residual renal function is associated with better survival, lower morbidity, and greater quality of life. To analyze the evolution of residual diuresis over time, we prospectively monitored urine output in 401 pediatric patients in the global IPPN registry who commenced peritoneal dialysis (PD) with significant residual renal function. Associations of patient characteristics and time-variant covariates with daily urine output and the risk of developing oligoanuria (under 100 ml/m2/day) were analyzed by mixed linear modeling and Cox regression analysis including time-varying covariates. With an average loss of daily urine volume of 130 ml/m2 per year, median time to oligoanuria was 48 months. Residual diuresis significantly subsided more rapidly in children with glomerulopathies, lower diuresis at start of PD, high ultrafiltration volume, and icodextrin use. Administration of diuretics significantly reduced oligoanuria risk, whereas the prescription of renin–angiotensin system antagonists significantly increased the risk oligoanuria. Urine output on PD was significantly associated in a negative manner with glomerulopathies (−584 ml/m2) and marginally with the use of icodextrin (−179 ml/m2) but positively associated with the use of biocompatible PD fluid (+111 ml/m2). Children in both Asia and North America had consistently lower urine output compared with those in Europe perhaps due to regional variances in therapy. Thus, in children undergoing PD, residual renal function depends strongly on the cause of underlying kidney disease and may be modifiable by diuretic therapy, peritoneal ultrafiltration, and choice of PD fluid.

Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group.

Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group.

Correlation between hypervolemia, left ventricular hypertrophy and fibroblast growth factor 23 in hemodialysis patients

Introduction: Left ventricular hypertrophy (LVH) is a significant risk factor for cardiovascular complications in hemodialysis (HD) patients. Hypervolemia has been accepted as an independent risk factor for progressive LVH in HD patients. Additionally, high FGF23 levels have been a significant predictor of cardiovascular mortality and morbidity in chronic kidney disease and HD patients. The aim of our study is to investigate the correlation among LVH, interdialytic volume increase and FGF-23 in the patients on a chronic hemodialysis program. Design and methods: A total of 97 chronic hemodialysis patients (64.43 ± 11.28 years old, M/F:47/50) were included in the study. Human FGF-23 ELISA kit was used for FGF-23 analysis of predialysis blood samples. Echocardiographic evaluation was performed in all of the patients after dialysis. Left Ventricular Mass Index (LVMI) was calculated by using the Devereux Formula. We collected the following data: LVMI, FGF-23 levels, interdialytic fluid gain, blood pressure changes, and the other biochemical and clinical parameters. Results: Mean LVMI of the patients was 184.41 ± 48.62 g/m2. LVMI of the patients with daily urine output >250 mL was found significantly lower. Statistically significant positive correlation was found between predialysis systolic blood pressure, predialysis diastolic blood pressure, predialysis mean arterial blood pressure and LVMI measurements (p < 0.01). Mean interdialytic volume excess was correlated with LVMI measurements of the patients (r = 0.459; p < 0.01). Increased FGF-23 levels (159.79 ± 134.99 ng/L) predicted increased LVMI measurements of the patients (r = 0.322; p < 0.01). In addition, FGF-23 levels were also increased as the interdialytic fluid volume increased (r = 0.326; p < 0.05). A positive correlation was also found between FGF-23 levels and interventricular septum thickness (r = 0.238; p < 0.05). Predialysis mean arterial blood pressure, predialysis volume overload and presence of diabetes were determined to be independent risk factors on LVMI on multivariate regression analysis. Conclusion: Our study showed that interdialytic volume overload increased both LVMI and FGF-23 values. We can consider that interdialytic volume control exerts positive effects on increased FGF-23 levels which predict the negative cardiovascular outcomes.

The urothelium of a hibernator: the American black bear.

The American black bear undergoes a 3–5 month winter hibernation during which time bears do not eat, drink, defecate, or urinate. During hibernation renal function (GFR) is 16–50% of normal but urine is reabsorbed across the urinary bladder (UB) urothelium thus enabling metabolic recycling of all urinary constituents. To elucidate the mechanism(s) whereby urine is reabsorbed, we examined the UBs of five nonhibernating wild bears using light, electron (EM), and confocal immunofluorescent (IF) microscopy–concentrating on two components of the urothelial permeability barrier – the umbrella cell apical membranes and tight junctions (TJ). Bear UB has the same tissue layers (serosa, muscularis, lamina propria, urothelia) and its urothelia has the same cell layers (basal, intermediate, umbrella cells) as other mammalians. By EM, the bear apical membrane demonstrated a typical mammalian scalloped appearance with hinge and plaque regions – the latter containing an asymmetric trilaminar membrane and, on IF, uroplakins Ia, IIIa, and IIIb. The umbrella cell TJs appeared similar to those in other mammals and also contained TJ proteins occludin and claudin - 4, and not claudin –2. Thus, we were unable to demonstrate urothelial apical membrane or TJ differences between active black bears and other mammals. Expression and localization of UT-B, AQP-1 and -3, and Na+, K+-ATPase on bear urothelial membranes was similar to that of other mammals. Similar studies of urothelia of hibernating bears, including evaluation of the apical membrane lipid bilayer and GAGs layer are warranted to elucidate the mechanism(s) whereby hibernating bears reabsorb their daily urine output and thus ensure successful hibernation.

Urinary proteomics in renal pathophysiology: Impact of proteinuria.

Urinary differential proteomics is used to study renal pathophysiological mechanisms, find novel markers of biological processes and renal diseases, and stratify patients according to proteomic profiles. The proteomic procedure determines the pathophysiological meaning and clinical relevance of results. Urine samples for differential proteomic studies are usually normalized by protein content, regardless of its pathophysiological characteristics. In the field of nephrology, this approach translates into the comparison of a different fraction of the total daily urine output between proteinuric and nonproteinuric samples. Accordingly, alterations in the level of specific proteins found by this method reflect the relative presence of individual proteins in the urine; but they do not necessarily show alterations in their daily excretion, which is a key parameter for the understanding of the pathophysiological meaning of urinary components. For renal pathophysiology studies and clinical biomarker identification or determination, an alternative proteomic concept providing complementary information is based on sample normalization by daily urine output, which directly informs on changes in the daily excretion of individual proteins. This is clinically important because daily excretion (rather than absolute or relative concentration) is the only self-normalized way to evaluate the real meaning of urinary parameters, which is also independent of urine concentration.

Intravenous amino acid therapy for kidney function in critically ill patients: a randomized controlled trial.

Acute kidney injury (AKI) is characterized by severe loss of glomerular filtration rate (GFR) and is associated with a prolonged intensive care unit (ICU) stay and increased risk of death. No interventions have yet been shown to prevent AKI or preserve GFR in critically ill patients. Evidence from mammalian physiology and small clinical trials suggests higher amino acid intake may protect the kidney from ischemic insults and thus may preserve GFR during critical illness. To determine whether amino acid therapy, achieved through daily intravenous (IV) supplementation with standard amino acids, preserves kidney function in critically ill patients. Multicenter, phase II, randomized clinical trial conducted between December 2010 and February 2013 in the ICUs of 16 community and tertiary hospitals in Australia and New Zealand. Participants were adult critically ill patients expected to remain in the study ICU for longer than 2 days. Random allocation to receive a daily supplement of up to 100 g of IV amino acids or standard care. Duration of renal dysfunction (primary outcome); estimated GFR (eGFR) derived from creatinine; eGFR derived from cystatin C; urinary output; renal replacement therapy (RRT) use; fluid balance and other measures of renal function. 474 patients were enrolled and randomized (235 to standard care, 239 to IV amino acid therapy). At time of enrollment, patients allocated to receive amino acid therapy had higher APACHE II scores (20.2 ± 6.8 vs. 21.7 ± 7.6, P = 0.02) and more patients had pre-existing renal dysfunction (29/235 vs. 44/239, P = 0.07). Duration of renal dysfunction after enrollment did not differ between groups (mean difference 0.21 AKI days per 10 patient ICU days, 95 % CI -0.27 to 1.04, P = 0.45). Amino acid therapy significantly improved eGFR (treatment group × time interaction, P = 0.004), with an early peak difference of 7.7 mL/min/1.73 m(2) (95 % CI 1.0-14.5 mL/min/1.73 m(2), P = 0.02) on study day 4. Daily urine output was also significantly increased (+300 mL/day, 95 % CI 145-455 mL, P = 0.0002). There was a trend towards increased RRT use in patients receiving amino acid therapy (13/235 vs. 25/239, P = 0.062); however, this trend was not present after controlling for baseline imbalance (P = 0.21). Treatment with a daily IV supplement of standard amino acids did not alter our primary outcome, duration of renal dysfunction. anzctr.org.au Identifier: ACTRN12609001015235.

Germanium in ginseng is low and causes no sodium and water retention or renal toxicity in the diuretic-resistant rats.

Ginseng preparations contain high concentrations of germanium (Ge), which was reported to contribute to diuretic resistance or renal failure. However, Ge content in ginseng and the influence on renal functions remain unclear. Forty rats were randomly divided into control group, low, moderate, and high Ge ginseng-treated group and observed for 25 days. Daily urine, renal functions, and serum and urine electrolytics were measured. Ge retention in the organs and renal histological changes were also evaluated. Ge content ranged from 0.007 to 0.450 µg/g in various ginseng samples. Four groups showed no difference in the daily urine output, glomerular filtration rate, urinary electrolytes excretions, 24 h-urine protein, as well as plasma and urine urea nitrogen, creatinine, osmotic pressure, and pH values. Ge did not cause any renal pathological effects in this study. No Na and water retention was detected in the ginseng-treated groups. Ge retention in various organs was found highest in spleen, followed by the kidney, liver, lung, stomach, heart, and pancreas. The total Ge contents in various ginsengs were low, and ginseng treatment did not affect renal functions or cause renal histological changes.

Factors influencing recoverability of renal function after urinary diversion through percutaneous nephrostomy.

Context:Various factors predict recoverability of kidney function preoperatively. Placement of percutaneous nephrostomy (PCN) and measuring the differential creatinine clearance (diff. %CrCl) is still regarded as a simple and reliable method.Aims:The aim was to evaluate correlation between renal cortical thickness (CT), hydronephrosis, intrapelvic pressure (IPP), PCN output, renal morphological factors such as length, width, echogenicity, corticomedullary differentiation (CMD), status of c/l kidney, and presence of infection which can predict recoverable function.Settings and Design:A prospective study done between July 2013 and June 2014 in Urology Department.Subjects and Methods:Hundred and sixty patients of supravesical obstruction for various causes who need PCN either due to chronic renal failure or nonvisualized kidney on contrast study, were included. IPP was measured during PCN placement. After 4 weeks 24 h urine was sent for CrCl and urine pH.Statistical Analysis Used:Correlation of continuous and categorical variables with dependent variable (diff. %CrCl) was formulated using spearman correlation and Mann–Whitney U test. Simple and multiple linear regression analysis were performed.Results:The study includes 160 patients with median age of 65.5 years. Hydronephrosis were due to stone in 76 (47.5%), pelviureteric junction obstruction (PUJO) in 40 (25%), cancer in 32 (20%), others in 12 cases (7.5%). IPP was <10 cm H2O in 48 (30%); 10–20 cm H2O in 64 (40%) and >20 cm H2O in 48 (30%). There was significant correlation between IPP and diff. %CrCl with correlation coefficient ρ = 0.509 (P = 0.0001).Conclusions:CT, parenchymal echogenicity, CMD, pre-PCN creatinine, and status of c/l kidney are the only independent variables which can predict the renal function while other variables like renal size, urine output, infection, hydronephrosis lost their statistical significance in multivariate analysis. Furthermore, IPP measured before PCN directly correlated with daily urine output and diff. %CrCl.

Systemic and renal hemodynamic effects of intra-arterial radiocontrast.

BackgroundDecreased renal blood flow (RBF) and vasoconstriction are considered major mechanisms of contrast-induced acute kidney injury (CIAKI). To understand the severity and duration of such putative effects, we measured systemic and renal hemodynamics after intra-arterial radiocontrast administration. The subjects were six Merino ewes. The setting was a university-affiliated research institute. This is a randomized cross-over experimental study.MethodsTransit-time flow probes were implanted on the pulmonary and left renal arteries 2 weeks before experimentation. We simulated percutaneous coronary intervention by administering five intra-arterial boluses of 0.5 mL/kg saline (control) or radiocontrast (iodixanol) to a total of 2.5 mL/kg over 1 h. Cardiac output (CO), heart rate, mean arterial pressure (MAP), RBF, renal vascular conductance (RVC), urine output (UO), creatinine clearance (CrCl), and fractional excretion of sodium (FENa) were measured.ResultsIn the first 8 h after intra-arterial administration of radiocontrast, CO, total peripheral conductance (TPC), and heart rate (HR) increased compared with those after normal saline administration. Thereafter, CO and TPC were similar between the two groups, but HR remained higher with radiocontrast (p < 0.001). After a short (30 min) period of renal vasoconstriction with preserved RBF secondary to an associated increase in MAP, RBF and RVC showed an earlier and greater increase (vasodilatation) with radiocontrast (p < 0.001) and remained higher during the first 2 days. Radiocontrast initially increased urine output (p < 0.001) and FENa (p = 0.003). However, the overall daily urine output decreased in the radiocontrast-treated animals at 2 days (p < 0.001) and 3 days (p = 0.006). Creatinine clearance was not affected.ConclusionsIn healthy animals, intra-arterial radiocontrast increased RBF, induced renal vasodilatation, and caused a delayed period of oliguria. Our findings suggest that sustained reduction in RBF and renal vasoconstriction may not occur in normal large mammals after intra-arterial radiocontrast administration.

Randomized, double blinded, placebo-controlled trial to evaluate the efficacy and safety of tolvaptan in Chinese patients with hyponatremia caused by SIADH.

To study the effect of tolvaptan on non-acute, non-hypovolemic hyponatremia in inappropriate secretion of antidiuretic hormone (SIADH) syndrome in Chinese patients. Hyponatremic SIADH patients received placebo (N = 18) or tolvaptan (N = 19) at an initial dose of 15 mg/day with further titration to 30 mg/day and 60 mg/day based on serum sodium concentrations. Randomized, double-blind, placebo-controlled trial. Primary endpoint was the change of the serum sodium from baseline to days 4 and 7. Analysis of covariance (ANCOVA) was used for statistical analysis. At day 4, average daily changes in serum sodium levels from baseline was 1.9 ± 2.9 mmol/L (1.9 ± 2.9 mEq/L) in the placebo group and 8.1 ± 3.6 mmol/L (8.1 ± 3.6 mEq/L) in the tolvaptan group; at day 7, the values were 2.5 ± 3.9 mmol/L (2.5 ± 3.9 mEq/L) and 8.6 ± 3.9 mmol/L (8.6 ± 3.9 mmEq/L) for the placebo and tolvaptan groups (ANCOVA, P < 0.001). At days 4 and 7, daily urine output and proportions of patients with normalized serum sodium were significantly superior in the tolvaptan group. The most common adverse events occurring in the tolvaptan group were dry mouth and thirst. Tolvaptan demonstrated superiority to placebo in the treatment of Chinese SIADH patients with hyponatremia by elevating serum sodium concentration with acceptable safety profile.

Electrochemical Disinfection of Liquid Human Waste for Developing World Application

This research reports the continued development of an electrochemical disinfection (ED) system for the treatment of liquid human waste. The system is a portion of a modular toilet designed for developing countries that will not require piped-in water, a sewer connection or outside electricity. Raut et al. (1) demonstrated the ability of the ED system to completely disinfect synthetic urine spiked with E. coli. This study reports the disinfection and total chlorine production capabilities of the system using field simulated conditions. The ED system is designed to treat liquid waste that has been separated from the solid waste deposited into the toilet. The effluent will contain urine, a small amount of fecal matter (~ 0.5% w/w), flush water, and cleansing water. This liquid waste will be treated to standards suitable for discharge to soil or for reuse as rinse or flush water.The ED system was tested with the expected daily output of urine and flush water from one person and the solids/liquids interaction with feces was simulated to obtain the desired fecal contamination. E. coli was chosen as the disinfection indicator with starting concentrations ranging from 2.5 x 104 – 1.4 x 107 MPN/mL. As shown in Figure 1, disinfection was achieved by 110 minutes of processing time at 12 V.Effective treatment of pathogens is expected to be a function of the production of chlorine containing species and other reactive oxygen species. However, to maintain disinfection in the system after ED treatment, a residual chlorine concentration is desired. Figure 2 shows the total and free chlorine produced over long electrochemical cell run times. Large amounts of chlorine were shown to be produced, however; most is consumed within 24 hours after the cell is turned off.The ED system has demonstrated effective disinfection of fecal-contaminated liquid waste in simulated field conditions. Continued research will include pilot testing and demonstration of the ED’s effectiveness at killing chlorine resistant pathogens. Acknowledgements Financial support for this work was provided by the Bill & Melinda Gates Foundation.

The effect of renal dose dopamine use on renal tubular function in diabetic patients undergoing coronary artery bypass graft surgery

Background: This study aims to evaluate clinical results of the prophylactic use of renal dose dopamine infusion in diabetic patients undergoing coronary artery bypass grafting (CABG). Methods: In this prospective randomized study, 40 consecutive diabetic patients who were scheduled for elective CABG were randomized into two equal groups: group 1 received dopamine infusion at renal dose (2.5-4.0 mg/kg/min) starting from induction of anesthesia for 48 hours; group 2 consisted of untreated controls. Standard sternotomy technique using aortic and right atrial cannulation was performed for cardiopulmonary bypass. Results: Daily urine output, fluid balance, serum creatinine, blood urea levels and creatinine clearance were measured at three and five days. In the control group, third and fifth postoperative day, creatinine clearance levels decreased about 24.8±12.3 mL/min and 18.1±10.1 mL/min, respectively. In the dopamine group, creatinine clearance levels in the third and fifth postoperative days increased by 7.7±10.8 mL/min (p=0.005) and 10.7±11.7 mL/min (p=0.001), respectively. Group 1 patients demonstrated less increase in serum creatinine level at three and five days than the controls (p

Terminology, epidemiology, etiology, and pathophysiology of nocturia

Nocturia, awaking from sleep to void, has a negative impact on health and well-being. Nocturia affects men and women and is more prevalent among the elderly. More than two nocturnal voids is considered to be a clinically meaningful threshold associated with significant negative outcomes for health and well-being, and the timing of awakening has a significant bearing on the negative consequences of nocturia. Several serious underlying pathophysiologic conditions may be associated with nocturia. A thorough history and assessment of number and times of voids, void volume, and fluid intake is essential for determining the etiology of a patient's nocturia. With data obtained from the frequency-volume chart (FVC), which is used to collect quantitative voiding data, a patient's nocturia may be classified as global polyuria, nocturnal polyuria, reduced bladder capacity, or a combination of these categories. Global polyuria is defined as 24-hr urinary output that exceeds 40 ml/kg body weight and results in increased 24-hr urinary frequency. Nocturnal polyuria is defined as more than 20% of daily urine output at night in young patients and more than 33% in elderly patients. Reduced bladder capacity may be a result of idiopathic or neurogenic detrusor overactivity, bladder outlet obstruction, or reduced nocturnal bladder capacity. The pathophysiology underlying the findings of the FVC falls into five main categories: global polyuria, nocturnal polyuria, reduced bladder capacity, sleep disorders, and circadian clock disorders. This review discusses the epidemiology, etiology, and pathophysiology of nocturia.

Effects of feeding frequency and dietary water content on voluntary physical activity in healthy adult cats

Low physical activity has been identified as a major risk factor for the development of feline obesity and diabetes. This study aimed to evaluate the effects of increased meal frequency and dietary water content on voluntary physical activity in cats fed to maintain BW. Ten adult lean neutered male cats were used in 2 tests, both crossover studies composed of a 14-d adaptation period, followed by a 7-d measurement of physical activity from d 15 to d 22 using Actical activity collars. Cats were group housed for most of the day, except for times when they were individually housed in cages to access their diet under a 16:8 h light:dark cycle. In Exp. 1, the difference in voluntary physical activity among cats fed 1, 2, 4, or a random number of meals per day were tested in a 4 × 4 Latin square design in 4 individual rooms. In Exp. 2, the effect of increasing dietary water content on voluntary physical activity was tested in a crossover design including a 5-d phase for fecal and urine collection from d 22 to 27. Cats were randomly assigned to 2 rooms and fed a dry commercial diet with or without added water (70% hydrated) twice daily. Activity levels were expressed as "activity counts" per epoch (15 s). In Exp. 1, average daily activity level for 1-meal-fed cats was lower than 4-meal-fed (P = 0.004) and random-meal-fed (P = 0.02) cats, especially during the light period. The activity level of cats during the dark period was greater in 1-meal-fed cats compared with cats fed 2 meals (P = 0.008) or 4 meals (P = 0.007) daily. Two-hour food anticipatory activity (FAA) before scheduled meal times for 1-meal-fed cats was lower (P < 0.001) than for the multiple-meal-fed cats. In Exp. 2, average daily activity level of cats fed the 70% hydrated diet tended to be higher (P = 0.06) than cats fed the dry diet, especially during the dark period (P = 0.007). Two-hour FAA before the afternoon meal for cats fed the 70% hydrated diet was lower (P < 0.05) than for cats fed the dry diet. Cats fed the 70% hydrated diet had greater daily fecal (P = 0.008) and urinary (P = 0.001) outputs and lower (P < 0.001) urinary specific gravity compared to cats fed the dry diet. In conclusion, increased feeding frequency and dietary water content, without changing energy intake or dietary macronutrient composition, appear to promote physical activity, which may aid in weight management in cats.

The role of human serum albumin therapy in the post-operative management of patients with hepatocellular carcinoma associated with cirrhosis

Objective To determine the role of human serum albumin therapy in the post-operative management of patients with hepatocellular carcinoma (HCC) associated with cirrhosis.Methods Between January 2011 and December 2012,we treated 171 consecutive cirrhotic patients with HCC.88 patients were treated with 5％ human serum albumin for 48 hours followed by 20％ human serum albumin in the post-operative period (the observer group) ; 81 patients were only treated with 20％ human serum albumin during the same time duration (the control group).The prognosis,complications,average amount of human serum albumin and plasma used as well as the in-hospital stay were observed.Results There were no deaths or major complications in either of these 2 groups.After treatment,the observer group was lower than the control group in the amount of intravenous fluid infused,the volume of peritoneal drainage,the amount of human serum albumin and plasma used as well as the mean post-operative hospitalization days (P ＜ 0.05).At the same time,the daily urine output,the central venous pressure and the mean arterial pressure within 48 hours after surgery were higher in the observer group than the control group.Furthermore the observer group had a smoother post-operative recovery in liver function,and the difference was significant between the two groups (P ＜ 0.05).Conclusion Not only did treatment with 5 ％ and 20％ human serum albumin gave the advantages of a more stable blood circulation,better organ perfusion and improved liver function recovery but it also reduced the amount of consumption of human serum albumin and plasma and shortened the hospital stay. Key words: Hepatocellular carcinoma; Liver function; Albumin; Liver neoplasm; Cirrhosis