Decrease In Glomerular Filtration Rate Research Articles

Causality of Genetically Determined Metabolites on Chronic Kidney Disease: A Two-Sample Mendelian Randomization Study In Silico.

Introduction: Chronic kidney disease (CKD) is associated with metabolic disorders. However, the evidence for the causality of circulating metabolites to promote or prevent CKD is still lacking. Methods: The two-sample Mendelian randomization (MR) analysis was conducted to evaluate the latent causal relationship between the genetically proxied 486 blood metabolites and CKD. Genome-wide association study (GWAS) data for exposures were derived from 7824 European GWAS on metabolite levels, which have been extensively utilized in the medical field to elucidate the mechanisms underlying disease onset and progression. The random inverse variance weighted (IVW) is the primary analysis for causality analysis while MR-Egger and weighted median as complementary analyses. For the further identification of metabolites, reverse MR and linkage disequilibrium score regression were performed for further evaluation. The drug target for N-acetylornithine was subsequently supplemented into the analysis, with MR and colocalization analysis being utilized. Key metabolic pathways were identified via MetaboAnalyst 4.0 (https://www.metaboanalyst.ca/) online website. Results: N-acetylornithine was identified as a reliable metabolite that increases the susceptibility to estimated glomerular filtration rate (eGFR) decrease (β = 0.047; 95% confidence interval: -0.068 to -0.026; PIVW = 1.5E-5). The "glyoxylate and dicarboxylate metabolism" pathway showed significant relevance to CKD development (P = 6E-4), whereas the "glycine, serine, and threonine metabolism" pathway was also recognized as associated with CKD by general practitioners (P = 7E-4). Colocalization analysis revealed a robust genetic link between N-acetylornithine and both CKD and eGFR, with 85.1% and 99.4% colocalization rates, respectively. IVW-MR analysis substantiated these findings with a significant positive association for CKD (odds ratio = 1.43, P = 4.7E-5) and a negative correlation with eGFR (b = -0.04, P = 1.13E-31). Conclusions: MR was utilized to explore the potential causal links between 61 genetic serum metabolites and CKD. N-acetylornithine and NAT8 were further explored as a potential therapeutic target for CKD treatment.

Factors affecting the sodium-glucose cotransporter 2 inhibitors-related initial decline in glomerular filtration rate and its possible effect on kidney outcome in chronic kidney disease with type 2 diabetes: The Japan Chronic Kidney Disease Database.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors often cause a transient decrease in glomerular filtration rate (GFR) shortly after the initiation, referred to as the 'initial drop'. However, the clinical significance of this initial drop in real-world practice remains unclear. Using the nationwide Japan Chronic Kidney Disease Database, we examined factors that affected the initial drop, in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). We also evaluated the effects of the initial drop on a composite kidney outcome (a decline in GFR of ≥50% or progression to end-stage kidney disease). Data from 2053 patients with CKD and T2DM newly prescribed an SGLT2 inhibitor were analysed. The follow-up period after SGLT2 inhibitor administration was 1015 days (interquartile range: 532, 1678). Multivariate linear regression models revealed that the concomitant use of the renin-angiotensin system inhibitors and diuretics, urinary protein levels ≥2+, and changes in GFR before the initiation of the SGLT2 inhibitor were associated with a larger initial GFR decline (β = -0.609, p = .039; β = -2.298, p < .001; β = -0.936, p = .048; β = -0.079, p < .001, respectively). Patients in the quartile with the largest initial GFR decline experienced a higher incidence of the subsequent composite kidney outcome than those in the other quartiles (p < .001). The concomitant use of renin-angiotensin system inhibitors and diuretics, higher urine protein levels and pre-treatment GFR changes were associated with a larger initial GFR decline. Of these factors, the use of a diuretic had the largest effect. Furthermore, patients with CKD and T2DM experiencing an excessive initial GFR drop might be at a higher risk of adverse kidney outcomes.

Long-term functional outcomes in patients undergoing radical nephrectomy for renal cell carcinoma and tumor thrombus.

Up to 15% of patients with locally advanced renal cell carcinoma (RCC) harbors tumor thrombus (TT). In those cases, radical nephrectomy (RN) and thrombectomy represents the standard of care. We assessed the impact of TT on long-term functional and oncological outcomes in a large contemporary cohort. Within a prospective maintained database, 1207 patients undergoing RN for non-metastatic RCC between 2000 and 2021 at a single tertiary centre were identified. Of these, 172 (14%) harbored TT. Multivariable logistic regression analyses evaluated the impact of TT on the risk of postoperative acute kidney injury (AKI). Multivariable Poisson regression analyses estimated the risk of long-term chronic kidney disease (CKD). Kaplan Meier plots estimated disease-free survival and cancer specific survival. Multivariable Cox regression models assessed the main predictors of clinical progression (CP) and cancer specific mortality (CSM). Patients with TT showed lower BMI (24 vs. 26kg/m2) and preoperative Hb (11 vs. 14g/mL; all-p < 0.05). Clinical tumor size was higher in patients with TT (9.6 vs. 6.5cm; p < 0.001). After adjusting for potential confounders, the presence of TT was significantly associated with a higher risk of postoperative AKI (OR 2.03, 95% CI 1.49-3.6; p < 0.001) and long-term CKD (OR: 1.32, 95% CI 1.10-1.58; p < 0.01). Notably, patients with TT showed worse long-term oncological outcomes and TT was a predictor for CP (2.02, CI 95% 1.49-2.73, p < 0.001) and CSM (HR 1.61, CI 95% 1.04-2.49, p < 0.03). The presence of TT in RCC patients represents a key risk factor for worse perioperative, as well as long-term renal function. Specifically, patients with TT harbor a significant and early estimated glomerular filtration rate (eGFR) decrease. However, despite TT patients show a greater eGFR decline after surgery, they retain acceptable renal function, which remains stable over time.

Impact of CT-determined low kidney volume on renal function decline: a propensity score-matched analysis

ObjectivesTo investigate the relationship between low kidney volume and subsequent estimated glomerular filtration rate (eGFR) decline in eGFR category G2 (60–89 mL/min/1.73 m2) population.MethodsIn this retrospective study, we evaluated 5531 individuals with eGFR category G2 who underwent medical checkups at our institution between November 2006 and October 2017. Exclusion criteria were absent for follow-up visit, missing data, prior renal surgery, current renal disease under treatment, large renal masses, and horseshoe kidney. We developed a 3D U-net-based automated system for renal volumetry on CT images. Participants were grouped by sex-specific kidney volume deviations set at mean minus one standard deviation. After 1:1 propensity score matching, we obtained 397 pairs of individuals in the low kidney volume (LKV) and control groups. The primary endpoint was progression of eGFR categories within 5 years, assessed using Cox regression analysis.ResultsThis study included 3220 individuals (mean age, 60.0 ± 9.7 years; men, n = 2209). The kidney volume was 404.6 ± 67.1 and 376.8 ± 68.0 cm3 in men and women, respectively. The low kidney volume (LKV) cutoff was 337.5 and 308.8 cm3 for men and women, respectively. LKV was a significant risk factor for the endpoint with an adjusted hazard ratio of 1.64 (95% confidence interval: 1.09–2.45; p = 0.02).ConclusionLow kidney volume may adversely affect subsequent eGFR maintenance; hence, the use of imaging metrics may help predict eGFR decline.Critical relevance statementLow kidney volume is a significant predictor of reduced kidney function over time; thus, kidney volume measurements could aid in early identification of individuals at risk for declining kidney health.Key points• This study explores how kidney volume affects subsequent kidney function maintenance.• Low kidney volume was associated with estimated glomerular filtration rate decreases.• Low kidney volume is a prognostic indicator of estimated glomerular filtration rate decline.Graphical

Updated Evaluation of Agalsidase Alfa Enzyme Replacement Therapy for Patients with Fabry Disease: Insights from Real-World Data.

The clinical use of agalsidase alfa as enzyme replacement therapy (ERT) for Fabry disease (FD) has spread since 2001, and a large body of evidence of its effectiveness has been collected. This review presents the clinical and laboratory results achieved with agalsidase alfa, which has been published in the literature. Agalsidase alfa infusion slows down or stops the progression of renal damage, expressed by reduction or stabilization of the annual decline of the glomerular filtration rate; yearly decrease of glomerular filtration rate (slope) sometimes is reduced until its stabilization. ERT prevents or reduces the occurrence of hypertrophic cardiomyopathy or slows the increase over time if it is already present. Moreover, regarding neurological manifestations, ERT improves neuropathic pain and quality of life, and recent data indicated that it may also prevent the burden of cerebrovascular disease. In addition to ERT's clinical benefits, crucial topics like the most appropriate time to start therapy and the role of anti-drug antibodies (ADA) are analyzed. Treatment with agalsidase alfa in patients with FD substantially improves their outcomes and enhances their quality of life in patients with FD.

Episode of renal dysfunction in a child with eating disorder: a case report

Among the various organ dysfunctions seriously affected by eating disorders (EDs) is kidney damage. The kidneys are vital organs responsible for several essential functions, including the balance of the body's acid-base and mineral metabolism, the removal and excretion of substances, and the regulation of blood volume and pressure. Eating disorders are a widespread and clinically relevant class of multiorgan disorders that occur mainly in adolescence. EDs often have serious clinical manifestations, which are determined by electrolyte imbalance, endocrine and mental disorders, renal failure, and other disorders. Common eating disorders discussed in the literature and frequently encountered in clinical practice are anorexia nervosa and bulimia nervosa. Anorexia nervosa is a type of abnormal eating behaviour that involves the consumption of very little food and may include intentional vomiting or the misuse of laxatives or diuretics. Kidneys perform a number of vital functions to maintain homeostasis in our body. One of the main functions of the kidneys is blood filtration and the removal of metabolic products. This allows you to maintain the optimal level of fluid and electrolytes and remove toxins. Restriction of fluid intake and abuse of diuretics can cause a decrease in blood flow to the kidneys and further renal failure. The result of the latter is the development of serious violations of vital functions. Low dietary protein intake in people following a restricted diet (restrictive anorexia) leads to a decrease in glomerular filtration rate (GFR) and renal plasma flow. Treatment of acute kidney injury on the background of volume deficit due to fluid loss involves its termination and hydration orally or with the help of intravenous infusions of physiological solution depending on the severity of volume deficit and kidney damage, which was observed and described in this clinical case. Aim. To analyze the peculiarities of kidney injury in a child with an eating disorder. Materials and Methods. A detailed analysis of the case history of a pediatric patient diagnosed with eating disorder complicated with an acute episode of renal dysfunction was done. Basic anamnestic, clinical, laboratory, and instrumental data were analyzed and given in the paper. A graphic presentation is done with PowerPoint. Results. We describe a 14-year-old female patient diagnosed with ED and acute kidney injury (AKI) leading to intensive care unit interventions. Conclusions. AKIs can result from a number of conditions that are common among anorexics and include dehydration, high blood pressure, toxins, inadequate nutrition and possibly altered electrolytes. Serum creatinine, blood urea nitrogen (BUN), glomerular filtration rate (GFR), and electrolytes are among the kidney function markers that need to be monitored in the early stages of AKI linked to anorexia. The right medical care, which includes normalizing blood pressure and adequate hydration, leads to the patient's recovery. Further follow-ups on kidney function in such patients are of high importance

Fractional excretion of total protein predicts renal prognosis in Japanese patients with primary membranous nephropathy

Abstract Background Primary membranous nephropathy (pMN) is one of the most common types of glomerulonephritis, with a third of patients progressing to renal insufficiency. Various prognostic factors have been reported, of which urinary protein and renal function are the most critical parameters. Fractional excretion of total protein (FETP) indicates protein leakage that accounts for creatinine kinetics and serum protein levels. In this study, we investigated the association between FETP and renal prognosis in pMN. Methods We retrospectively identified 150 patients with pMN. FETP was calculated as follows: (serum creatinine × urine protein)/(serum protein × urine creatinine) %. We divided the patients into three groups according to FETP values and compared the clinicopathological findings. The primary outcome was an estimated glomerular filtration rate (eGFR) decrease of ≥ 30% from the baseline level. Results FETP was associated with urinary protein and renal function, Ehrenreich and Churg stage, and global glomerulosclerosis. The primary outcome was observed in 38 patients (25.3%), and the frequency of the primary outcome was higher in the higher FETP group (P = 0.001). FETP is higher than protein–creatinine ratio (PCR) in the area under the curve. In the multivariate analysis adjusted for age, eGFR, PCR, and treatment, FETP was significantly associated with primary outcome (adjusted hazard ratio, 8.19; P &amp;lt; 0.019). Conclusions FETP is a valuable indicator that can reflect the pathophysiology and is more useful than PCR as a predictor of renal prognosis in patients with Japanese pMN.

Analysis of glomerulopathies in kidney neoplasms

Background. Malignant neoplasms, including those of the kidneys, are widespread in the world. The main treatment for kidney tumors is surgery, one of its options is nephrectomy. Malignant tumors of various localizations can lead to a variety of kidney damage. Glomerulopathies of various origins are often asymptomatic, and therefore, patients do not seek medical help. For the diagnosis of glomerulopathies, it is necessary to assess morphological changes with the formulation of an immunofluorescence reaction and electron microscopy.The aim: to analyze the clinical manifestations, frequency and structure of glomerulopathies in kidney neoplasms.Patients and Methods. The study included 141 patients. The patients underwent nephrectomy, the daily protein loss, the number of altered erythrocytes in the urine, the level of creatinine in the blood serum were determined, and the glomerular filtration rate (CKD-EPI) was calculated. Morphological evaluation of samples included immunofluorescence reaction and electron microscopy. To assess the statistical significance of the relationship between variables, Spearman's nonparametric rank correlation coefficient (Rs) was calculated. The results obtained were considered significant at p&lt;0.05. RESULTS. Glomerulopathies were detected in 41.8 % of patients. Glomerulonephritis was observed in 10.6 % of cases and diabetic nephropathy was detected in 31.2 % of patients. Prior to nephrectomy, proteinuria was higher in patients with glomerulonephritis; after surgical treatment, there were no differences in the level of proteinuria. Before nephrectomy, there were no significant differences in glomerular filtration rate; after surgery, glomerular filtration rate was higher in patients without glomerular pathology. After one year, there was a significant decrease in glomerular filtration rate in patients with glomerulopathies. CONCLUSION. When examining the surgical material, the morphologist should also evaluate changes in the kidney tissue outside the tumor. It is advisable to jointly manage the patient by an oncologist and a nephrologist Keywords: tumor, glomerulonephritis, diabetic nephropathy, glomerular filtration rate&gt; ˂ 0.05.Results. Glomerulopathies were detected in 41.8 % of patients. Glomerulonephritis was observed in 10.6 % of cases and diabetic nephropathy was detected in 31.2 % of patients. Prior to nephrectomy, proteinuria was higher in patients with glomerulonephritis; after surgical treatment, there were no differences in the level of proteinuria. Before nephrectomy, there were no significant differences in glomerular filtration rate; after surgery, glomerular filtration rate was higher in patients without glomerular pathology. After one year, there was a significant decrease in glomerular filtration rate in patients with glomerulopathies.Conclusion. When examining the surgical material, the morphologist should also evaluate changes in the kidney tissue outside the tumor. It is advisable to jointly manage the patient by an oncologist and a nephrologist.

Rein et diabète ne font pas bon ménage

AbstractThis clinical case shows bad household between diabetes and kidney, and when arterial hypertension gets in the way! A woman with diabetes for a long time and treated with metformin presents metabolic syndrome with type 2 diabetes, arterial hypertension difficultly controlled by antihypertensive drugs, dyslipidaemia and chronic kidney failure (CKF) which worsens regularly. Gradually, glucose in excess in blood plasma glycosylates renal glomerular membranes meaning to diabetes nephropathy, which can be revealed by a nephrotic syndrome, no pure as in the present case with an arterial hypertension resistant to therapy. Acute kidney failure crisis is in the frame of CKF, which worsens with decline of glomerular filtration rate (GFR), large increase in albuminuria and heavy antihypertensive therapy. Vicious circle sets in because CKF increases arterial tension meaning to enhance antihypertensive therapy itself toxic for the kidney. To break this vicious circle, on the one hand we have to better control diabetes and on the other hand, to control hypertension by choosing drugs protective for the kidney. Every new decrease in GFR or increase in albuminuria makes you fear of a new acute renal failure crisis that you have to take care quickly. Diabetes is the main cause of renal transplantation.

Role of perirenal adiposity in renal dysfunction among CKD individuals with or without diabetes: a Japanese cross-sectional study

IntroductionIt remains unclear whether increased perirenal fat (PRF) accumulation is equally related to renal involvement in patients with and without diabetes mellitus (DM). We evaluated the association between PRF volume...

Acute kidney injury in patients undergoing endovascular or open repair of juxtarenal or pararenal aortic aneurysms

BackgroundThe aim of this cohort study was to report the proportion of patients who develop periprocedural acute kidney injury (AKI) after endovascular repair (ER) and open surgery (OS) in patients with juxta/pararenal abdominal aortic aneurysm and to assess potential risk factors for AKI. The study also aimed to report the short- and long-term outcomes of patients with and without AKI. MethodsThis was a multicenter cohort study of five European academic high-volume centers (>50 OS or 50 ER infrarenal AAA repairs, plus >15 complex AAA repairs per year). All consecutively treated patients were extracted from a prospective vascular surgical registry and the data were scrutinized retrospectively. The primary end point for this study was the development of AKI. AKI was diagnosed when there is a two-fold increase of serum creatinine or decrease of glomerular filtration rate of >50% within 1 week of AAA repair. Secondary end points included long-term mortality and end-stage renal disease (ESRD). ResultsAKI occurred in 16.6% of patients in the ER group vs 30.3% in the OS group (P < .001). The 30-day mortality rate was higher among patients with AKI in both ER (15.4% vs 3.1%; P = .006) and OS (13.2% vs 5.3%; P = .001) groups. Age, chronic kidney disease, presence of significant thrombus burden in the pararenal region, >1000 mL blood loss in ER group were associated with development of AKI. Age, diabetes mellitus, chronic kidney disease, presence of significant thrombus burden in the pararenal region, and a proximal clamping time of >30 minutes in the OS group were associated with the development of AKI, whereas renal perfusion during clamping was the protective factor against AKI development. After a median follow-up of 91 months, AKI was associated with higher mortality rates in both the ER group (58.9% vs 29.7%; P < .001) and the OS group (61.5% vs 27.3%; P < .001). After the same follow-up period, AKI was associated with a higher incidence of ESRD in both the ER group (12.8% vs 3.6%; P = .009) and the OS group (9.9% vs 2.9%; P < .001). ConclusionsThe current study identified important pre and postoperative factors associated with AKI after juxta/pararenal abdominal aortic aneurysm repair. Patients with postoperative AKI had significantly higher short- and long term mortality and higher incidence of ESRD than patients without AKI.

GAMBARAN FUNGSI GINJAL PASIEN DIABETES MELITUS TIPE II DI PUSKESMAS TLOGOSARI KULON KOTA SEMARANG

Type II Diabetes Mellitus (DMTII) patients who are not treated properly can experience decreased renal function. The use of oral hypoglycemic drugs (OHG) can cause a decrease in renal function. Glomerular Filtration Rate (GFR) can describe a decrease in renal function. The aim of this study was to determine the description of renal function in DMTII patients at the Tlogosari Kulon Health Center, Semarang City. This research is a descriptive observational study. The sampling technique used was purposive sampling. Data was obtained from medical records of DMTII patients for the period September–December 2022. The inclusion criteria were patients with DMTII who received OHG therapy for at least one year, aged ≥45 years, had the most recent serum creatinine examination, with or without comorbidities. If the patient's data is incomplete or the patient has a history of renal problems, they will be excluded. Based on the research results, it was discovered that there were 55 DMTII patients, consisting of 39 patients (70.90%) women and 16 patients (29.10%) men. A total of 29 patients were aged between 60-69 years (52.73%). A total of 39 patients had comorbidities such as hypertension and/or dyslipidemia. A total of 76.36% received OHG combination therapy. Forty percent of patients experienced a decrease in GFR from mild-moderate to severe. The decrease in GFR is caused by the amount of OHG consumed and comorbid hypertension

Multiplex analysis of post-Covid cardiorenal complications in patients with type 1 and type 2 diabetes mellitus according to the mobile diagnostic and treatment center (Diamobil)

BACKGROUND: Patients with diabetes mellitus (DM) are at risk for a higher incidence and severity of COVID-19, as well as its adverse outcomes, including post-Covid syndrome.AIM: to assess the incidence of cardiorenal complications in patients with type 1 and type 2 diabetes (T1DM/T2DM) who have had COVID-19, and to analyze the structure and severity of disorders according to examination data at the Diamobil mobile medical diagnostic and treatment center.MATERIALS AND METHODS: a cohort of T1DM and T2DM patients examined in Diamobil (n=318), with a confirmed anamnesis of COVID-19 (n=236). The time interval between COVID-19 and the visit to Diamobil was 8.7/8.2 months for T1DM/T2DM. The parameters of the last visit before COVID-19 recorded in the Federal Register of Diabetes (FRD) were used as initial data.RESULTS: Clinical characteristics of patients with T1DM/T2DM: age — 49.2/64.5 years, duration of DM — 22/11 years, proportion of women — 64/73%, respectively. After analysis the data from visits before and after COVID-19 there weren’t statistically significant differences in HbA1c levels for both types of DM (before 9.0/8.3%; after 8.4/8.2%, respectively), there was the intensification of glucose lowering therapy (the proportion of patients with T2DM on 2 and 3 component therapy increased by 4.3% and 1.6%, the proportion of patients on insulin therapy by 16%). After COVID-19, there was a statistically significant decrease in glomerular filtration rate (GFR) in T1DM from 88.1 to 62 ml/min/1.73 m2; with T2DM from 74.7 to 54.1 ml/min/1.73 m2. When assessing acute diabetic complications, there was an increase in the frequency of coma in T1DM by 1.5 times, severe hypoglycemia in T1DM by 3 times, and in T2DM by 1.7 times. Analysis of the frequency of cardiorenal complications before and after COVID-19 showed a total increase of 8.5% in T1DM, by 13.2% in T2DM, of which myocardial infarction, ischemic heart disease, and CHF increased in T1DM in the range from 1.5 to 5 times, with T2DM by 1.3 times, the frequency of CKD with T1DM by 1.5 times, with T2DM by 5.6 times.CONCLUSION: There was a decline of kidney filtration function (decrease in GFR) and an increase in the frequency of cardiovascular complications in both types of diabetes in post-Covid period while patients achieved a stable HbA1c levels by intensifying therapy during the COVID-19 infection. This fact reflects combined damage to the kidney and cardiovascular system as a part of the post-Covid syndrome and determines a key set of measures for the development of preventive strategies.

[Pituitary disorders in patients with end-stage chronic renal failure].

Disorders in the kidneys lead to disturbance of homeostasis. As the glomerular filtration rate decreases, the metabolism of numerous biologically active substances, including pituitary hormones, decreases. The article presents an overview of pituitary dysfunction in patients with chronic kidney disease (CKD) and discusses the possible reasons of the pathogenetic mechanisms. Particular focus is being given to the assessment of changes in the concentration of pituitary hormones in patients with end-stage chronic kidney disease (CKD) and discusses the pathogenetic mechanisms of their formation. Particular attention is paid to the assessment of changes in the concentration of pituitary hormones in patients receiving renal replacement therapy (RRT). CKD leads to an increase in the level of prolactin, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Concentrations of growth hormone (GH), isulin-like growth factor-1 (IGF-1), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH) and vasopressin may remain within normal values or increase in this group of patients. RRT does not reduce the levels of prolactin, LH, FSH, while the concentration of growth hormone, IGF-1, TSH tends to normalize. The content of ACTH and vasopressin may remain unchanged or decrease. Kidney transplantation in most cases corrects hormonal disorders. Correction of hormonal changes can improve the clinical outcome and quality of life of patients with end stage CKD.

Enhancing Efficacy and Safety in Laparoscopic Partial Nephrectomy for Localized Renal Tuberculosis: The Skirted Continuous Suture Technique.

BACKGROUND Limited research has been conducted on laparoscopic partial nephrectomy for kidney tuberculosis. This study aimed to evaluate the effectiveness of the skirted continuous suture technique in laparoscopic partial nephrectomy for localized renal tuberculosis. MATERIAL AND METHODS Five patients with kidney tuberculosis underwent standard retroperitoneal laparoscopic partial nephrectomy after computed tomography evaluation. The skirted continuous suture technique was utilized during the procedure. This retrospective study analyzed the outcomes of these patients who received treatment between January 2011 and December 2020 at Beijing Tsinghua Changgung Hospital and Eighth Medical Center of Chinese People's Liberation Army General Hospital. RESULTS The surgical success rate was 100%. Renal function was well preserved, with a decrease of glomerular filtration rate by 9.6±9.0 ml/min. Only 1 patient experienced postoperative urinous infiltration and lymphatic fistula, while the others did not have any surgical complications. Antituberculous therapy was continued postoperatively, and 1 patient had recurrence during follow-up. CONCLUSIONS The laparoscopic continuous suturing technique offers a reliable and straightforward method for extensively closing incision edges of the renal parenchyma in laparoscopic surgery. It contributes to the improved efficacy and safety of treating localized renal tuberculosis with exceptional application.

Analysis of diabetic nephropathy in type 2 diabetes mellitus and prediabetes

Background. Malignant neoplasms are widespread, and the ambiguous relationship between them and hyperglycemia emphasizes the importance of studying them. On the one hand, diabetes mellitus and prediabetes increase the risk of developing malignant tumors. On the other hand, malignant tumors and drugs intended for their treatment can lead to hyperglycemia. Regardless of the origin, diabetes mellitus and prediabetes may develop diabetic nephropathy. Aim of study: to analyze the functional state of the kidneys in patients with diabetes mellitus and prediabetes with kidney neoplasms.Object and methods. There was a study of 141 patients with a kidney tumor who underwent nephrectomy. For histological examination, a fragment of the kidney parenchyma was taken at a distance of at least 4 cm from the tumor. Histochemical stains, immunofluorescence reaction and electron microscopy were performed. Assessment of laboratory parameters was carried out before the surgical treatment, 3 days, 3 months, six months and a year after the operation. Parameters such as the level of protein in the urine, the presence and number of altered erythrocytes in the urine, and the glomerular filtration rate were assessed using the CKD-EPI formula.Result. Diabetic nephropathy was detected in 44 patients (31.2%). Diabetes mellitus was previously diagnosed in 10 patients (22.7%), prediabetes was diagnosed in 34 patients (77.3%). After nephrectomy, patients with prediabetes and type 2 diabetes mellitus showed a sharp decrease in glomerular filtration rate (GFR). In the subsequent period, in patients with type 2 diabetes, there is a stable decrease in GFR. In patients with prediabetes, hyperfiltration is observed within six months, however, a year after the operation, GFR decreases again.Conclusion. Widespread diabetic nephropathy in patients, it is advisable to jointly manage patients with an oncologist, nephrologist, endocrinologist, clinical pharmacologist.

Determinants of diabetic nephropathy among adult diabetic patients on follow-up at public hospitals in Addis Ababa, Ethiopia: A case-control study.

Diabetic nephropathy is defined as patients with diabetes mellitus who have persistent proteinuria for at least three consecutive measurements per year, a high blood creatinine level (>130 mol/l), or a decrease in glomerular filtration rate (<60 ml/min). Limited studies were done in Ethiopia on determinants of diabetic nephropathy among diabetic patients. Therefore, this study aimed to identify determinants of nephropathy among adult diabetic patients on follow-up at public hospitals in Addis Ababa, Ethiopia, 2022. A hospital-based unmatched case-control study design was conducted from 6 September to 9 November 2022, among diabetic patients on follow-up at public health hospitals in Addis Ababa. Using consecutive sampling techniques, a total of 442 (353 controls and 89 cases) were recruited, with a control-to-case ratio of 4:1. The data were collected using a structured and interview-administered questionnaire and variables like high-density lipoprotein, low-density lipoprotein, Glycated hemoglobin, and type of diabetes were extracted from the medical records of the patients using a checklist. The collected data were entered into Epidata 3.1 and analyzed by STATA version 15.0. Variables with a p-value < 0.25 in the bivariable logistic regression were selected for the final model. In multivariable logistic regression model fitting, variables with a p-value < 0.05 with 95% CI adjusted odds ratio have declared statistically significant risk factors of diabetic nephropathy. In this study, out of 442 study participants, 334 controls and 89 cases were included in the analysis, with a response rate of 94.6% and 100%, respectively. The majority of the study participants were 92.13% of cases and 84.13% of controls; 7.87% of cases, and 15.87% of controls were type 2 diabetes mellitus. Age 65 and above years old (AOR: 2.42; 95% CI: 1.28, 4.57); Smoking cigarette (AOR: 2.22; 95% CI: 1.18, 4.16); Non-adherent to diet (AOR: 2.11; 95% CI: 1.15, 3.84); Drinking alcohols (AOR: 1.95; 95% CI: 1.07, 3.52); Duration with diabetes more than 10 years (AOR: 3.39; 95% CI: 1.76, 6.54); Poor glycemic control (AOR: 2.19; 95% CI: 1.23, 4.28); and Low-density lipoprotein (AOR: 2.97; 95% CI: 1.69, 5.28) were found to be statistically significant risk factors of nephropathy among diabetic patients. This study found that old age, smoking cigarettes, non-adherence to diet, duration of diabetes, alcohol drinking, Glycated hemoglobin A1C, and high low-density lipoprotein were risk factors for nephropathy. Hence, continuous health education on lifestyle modifications and diabetic-related complications in each follow-up visit via front-line health professionals are very essential to avert the problem.

ERYTHROPOIETIN SYNTESIS IN PATIENTS WITH CHRONIC HEART FAILURE DEPENDING ON COMORBID PATHOLOGY

Introduction. Decreased production of erythropoietin by the kidneys plays crucial role in the development of anemia in patients with chronic heart failure, especially on the background of comorbid diabetes mellitus type 2. In diabetic patients due to early damage of the kidney vessels and following erythropoietin deficiency anemia develops much earlier than clinically significant decrease of glomerular filtration rate.&#x0D; The aim of the study was to find out possible dependence of changes in the erythropoietinsynthesizing function of the kidneys on the degree of severity of anemic hypoxia in elderly and senile patients with chronic heart failure, including those with comorbid type 2 diabetes mellitus.&#x0D; Materials and methods. 120 patients with chronic heart failure of ischemic origin, type 2 diabetes mellitus and mild and moderate anemia were examined. Control group comprised 12 people with chronic heart failure without comorbid pathology. The examined groups were comparable in terms of gender and age, differing in the presence of comorbid diabetes mellitus and degree of severity of anemic syndrome. The level of erythropoietin in blood serum was determined by standard enzymelinked immunosorbent assay.&#x0D; Results. Type 2 diabetes mellitus in patients with chronic heart failure results in a significant decrease in erythropoietin production by 25 % compared to the control group (p&lt;0,05). Comorbid to heart failure anemia leads to an increase in the level of erythropoietin by 74,4 % (р&lt;0,05), and in the case of chronic heart failure and type 2 diabetes mellitus on the background of concomitant anemia – only by 39,5 % (р&lt;0,05). As the severity of anemia in patients with chronic heart failure without diabetes progresses, the severity of the compensatory response of the kidneys to chronic anemic hypoxia is significantly higher than in patients with heart failure and comorbid type 2 diabetes.&#x0D; Conclusions. Diabetic nephropathy in patients with chronic heart failure and comorbid anemia leads to a significant deterioration of the erythropoietin-synthesizing function of the kidneys, complicating the course of both main and comorbid diseases.

A model of hemodialysis after acute kidney injury in rats

BackgroundAcute kidney injury (AKI) is frequent among critically ill patients. Renal replacement therapy (RRT) is often required to deal with severe complications of AKI. This technique is however associated with side effects such as hemodynamic instability and delayed renal recovery. In this study, we aimed to describe a novel model of hemodialysis in rats with AKI and depict a dialysis membrane performance.MethodsEighteen Sprague–Dawley rats received 0.75% adenine-rich diet to induce AKI. After 2 weeks, nine underwent an arterio-venous extracorporeal circulation (ECC) (ECC group) for 2 h without a dialysis membrane on the circuit and nine received a hemodialysis session (HD group) for 2 h with an ECC circuit. All rats were hemodynamically monitored, and glomerular filtration rate (GFR) was measured by transcutaneous fluorescence after the injection of FITC-Sinistrin. Blood samples were collected at different time points to assess serum creatinine and serum urea concentrations and to determine the Kt/V. Sinistrin concentration was also quantified in both plasma and dialysis effluent.ResultsAfter 2 weeks of adenine-rich diet, rats exhibited a decrease in GFR. Both serum urea and serum creatinine concentrations increased in the ECC group but remained stable in the HD group. We found no significant difference in serum creatinine and serum urea concentrations between groups. At the end of experiments, mean serum urea was 36.7 mmol/l (95%CI 19.7–46.9 mmol/l) and 23.6 mmol/l (95%CI 15.2–33.5 mmol/l) in the ECC and HD groups, respectively (p = 0.15), and mean serum creatinine concentration was 158.0 µmol/l (95%CI 108.1–191.9 µmol/l) and 114.0 µmol/l (95%CI 90.2–140.9 µmol/l) in the ECC and HD groups, respectively (p = 0.11). The Kt/V of the model was estimated at 0.23. Sinistrin quantity in the ultrafiltrate raised steadily during the dialysis session. After 2 h, the median quantity was 149.2 µg (95% CI 99.7–250.3 µg).ConclusionsThis hemodialysis model is an acceptable compromise between the requirement of hemodynamic tolerance which implies reducing extracorporeal blood volume (using a small dialyzer) and the demonstration that diffusion of molecules through the membrane is achieved.

The clinical significance of the determination of urinary biomarkers of podocytic damage and fibroangiogenesis in patients with diabetes mellitus

Chronic kidney disease (CKD) in patients with diabetes mellitus (DM) remains a global medical and social problem of the 21st century and the leading cause of end-stage renal disease (ESRD). Kidney damage in diabetes is multifactorial, and diagnosis is often delayed, since structural changes in the glomeruli of the kidneys are detected before the appearance of significant albuminuria (AU) and a decrease in glomerular filtration rate. In this regard, the search for new, early informative biomarkers for the diagnosis of CKD in patients with DM is extremely relevant.Target: To establish the significance of biomarkers of podocyte dysfunction and fibro and angiogenesis excreted in the urine for early diagnosis and assessment of the risk of progression of kidney damage in patients with DM. Materials and Methods: in 74 patients with type 1 and type 2 diabetes (30 and 44, respectively), podocyte proteins and markers of fibro and angiogenesis were determined in the urine by enzyme immunoassay.Results: in patients with diabetes, compared to healthy people, there is increased urinary excretion of podocyte damage markers - nephrin, podocin, and fibroaniogenesis markers – type IV collagen, TGFβ-1, VEGF. Concentrations of nephrin in urine &gt;7.18 ng/U/Cr urine and collagen &gt;12.88 ng/U/Cr urine reliably indicate kidney damage. In patients with diabetes in the absence of traditional signs of CKD, diagnostically significant concentrations of nephrin were detected in 22% of cases, and collagen in 16.6%.Conclusion: determination of nephrin and/or type IV collagen in urine can be used both for early diagnosis and for monitoring kidney damage in diabetes.