Determination Of Serum Creatinine Research Articles

Preoperative Fasting Blood Glucose Levels and the Risk of Contrast-Induced Nephropathy in Patients With Diabetes and Pre-diabetes Undergoing Coronary Arteriography or Percutaneous Coronary Intervention: A Cross-Sectional Study.

Diabetes mellitus is an independent risk factor for contrast-induced nephropathy (CIN) in patients undergoing coronary arteriography/percutaneous coronary intervention (CAG/PCI). We evaluated whether preoperative fasting blood glucose (FBG) levels in diabetic and pre-diabetic patients who underwent CAG/PCI influenced the occurrence of CIN. From June 1, 2020, to February 28, 2021, 687 patients were divided into five groups based on their preoperative FBG levels. Blood samples were collected at admission and at 48hours and 72hours after the procedure to determine serum creatinine levels. The P value for trend was used to analyze the trend between preoperative FBG levels and the increased risk of CIN. Univariable and multivariable logistic regression analysis were used to exclude the influence of confounding factors, and some high-risk confounders were selected for subgroup analysis. The results of our cross-sectional study show that elevated preoperative FBG levels are independently associated with the risk of CIN in diabetic and pre-diabetic patients undergoing CAG/PCI. Furthermore, the incidence of CIN gradually increases with the rise in preoperative FBG levels. Patients with elevated preoperative FBG at admission should be carefully monitored and more active measures should be taken to prevent CIN.

Značaj nefroprotektivnog efekta sartana u terapiji hipertenzije

Arterial hypertension can be both a cause and a consequence of renal dysfunction. Assessment of the existence of impaired renal function, determination of serum creatinine and urate, as well as the ratio of albumin and creatinine in urine, is an integral part of the diagnostic algorithm for patients with arterial hypertension. The main postulates for the treatment of hypertension in patients with renal dysfunction, regardless of the presence of diabetes mellitus, include good control of blood pressure and reduction of proteinuria. Attenuation of the renin-angiotensin-aldosterone system by angiotensin-converting enzyme inhibitors and angiotensin II receptor type 1 blockers (sartans) slows renal impairment in diabetic and hypertensive nephropathy. However, their simultaneous use is contraindicated, because it does not lead to a reduction in cardiovascular mortality and morbidity, and increases the risk of hypotension, hyperkalemia and adverse renal outcomes. In this review article, we summarize in a practical way the most important aspects of early detection and treatment of renal damage in patients with hypertension, with special emphasis on the importance of nephroprotective effects of sartan.

Methods to improve the accuracy of spectrophotometer determination of serum creatinine

In order to solve a series of problems that affect the accuracy of spectral quantitative analysis of complex solution components, based on the “M + N” theory, this paper proposes a system for quantitative analysis of serum components by spectroscopy. At the same time, feasible methods are used in each step of the system to effectively reduce the influence of noise and interference factors, and obtain the spectral signal of serum components with high signal-to-noise ratio, so that the model has good prediction performance. In this paper, serum creatinine was taken as the research object. This paper collects multi-location and multi-mode spectral data, and uses the wavelength elimination method to optimize the wavelength to avoid over-fitting, then, based on PLS modeling, the cubic fitting is used to optimize the model, so as to reduce the influence of spectral nonlinearity caused by the scattering characteristics of solution components. After using the above methods, the prediction ability and robustness of the model are improved. Compared with the results without these methods, the correlation coefficient of creatinine concentration of all samples predicted by the model established by using the reasonable methods is increased by 32.43%, and the root mean square error is reduced by 53.61%. The above experiments show that this article combines multi-mode spectrum, the wavelength variable optimization method, the cubic equation optimization model method and other methods to quantitatively analyze the complex solution components based on the spectrum, which can improve the accuracy and robustness of the results.

Association between plasma endothelial microparticles and contrast-induced nephropathy in patients underwent coronary angiography.

We aim to investigate the association between plasma endothelial microparticles (EMPs) and contrast-induced nephropathy of patients underwent coronary angiography.The patients were divided into normal renal function group and renal dysfunction group based on the estimated glomerular filtration rate (eGFR). Among the 180 cases, 117 received determination of EMP and serum creatinine after percutaneous coronary intervention (PCI) and/or coronary angiography. The patients were divided into contrast-induced-nephropathy (CIN) group and non-CIN group. EMPs collection and determination were performed, together with biochemical analysis and digital subtraction angiography (DSA) analysis.Spearman correlation showed that the expression of EMP was negatively correlated with eGFR (r = –0.201, P < .01). The serum hypersensitive C-reactive protein (hs-CRP), cystatin C (Cys-C), uric acid (UA) were significantly higher in CIN group than that in the non CIN group. Spearman correlation showed that the expression of EMP was positively correlated with serum interleukin-6 (IL-6, r = 0.393, P < .01). The expression of EMP was positively correlated with serum hs-CRP (r = 0.360, P < .01). Logistic regression analysis showed that the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), eGFR, UA, and Cys-C were correlated with the incidence of contrast induced nephropathy.In patients with contrast-induced-nephropathy, the plasma EMPs were significantly increased after coronary angiography. The expression of plasma EMPs may play a role in the occurrence of contrast-induced-nephropathy.

Molecularly imprinted polymer capped near infrared fluorescent emitting Ag2S-functionalized-COOH quantum dots for detection of creatinine as a nanosensor with high sensitivity and selectivity

Maintaining creatinine at high and low level is critical because it causes so many problems such as diabetic nephropathy, muscular dystrophy, renal failure, and urinary tract blocking. In this study, a high-performance near-infrared fluorescent Ag2S-functionalized-COOH quantum dots (QDs) capped with molecularly imprinted polymer (MIP) was developed (Ag2S@MIP) and used as a facile selective and sensitive detector for creatinine. Ethylene glycol dimethacrylate as cross-linker and creatinine as template molecules was used to prepare Ag2S@MIP fluorescent nanoparticles (∼42 nm) of the core-shell structure and by grafting methacrylic acid monomer on the surface of methacrylate-functionalized Ag2S QDs using suspension polymerization.The Ag2S@MIP nanoparticles were prepared and characterized by FESEM, FT-IR, DLS, TGA, XRD, and EDS. The Ag2S@MIP nanoparticles displayed a fluorescence emission band at ∼834 nm and quenched strongly upon the addition of creatinine. The adsorption of creatinine at various experimental conditions such as fluorescent emission, selectivity, adsorption/desorption processes, and reusability of Ag2S@MIP was measured. The outstanding adsorption capacity (∼492 mg/g) and the selectivity factor of Ag2S@MIP give a promising sensor for the detection and determination of creatinine in the human serum.

MO591THE EVALUATION OF SARCOPENIA IN NON-DIALYSIS CHRONIC KIDNEY DISEASE STAGES BY COMPUTED TOMOGRAPHY

Abstract Background and Aims Sarcopenia is common in chronic kidney disease (CKD) and it has been reported a correlation between the increased prevalence of sarcopenia and worsening kidney function. Computed tomography (CT) is the gold standard for studying sarcopenia because of its capacity to identify quantitative and qualitative changes in muscle mass. Our major aim was to evaluate the prevalence of sarcopenia ant its association with renal function, in non-dialysis CKD patients, using a diagnostic criterion that has not been applied before in this population. Method We conducted a longitudinal retrospective analysis on a cohort of non-dialysis CKD patients who visited an outpatient Nephrology clinic between January 2012 and December 2012 and continued follow-up until December 2018. We selected those who underwent a CT scan as part of their clinical workup and simultaneously had a serum creatinine determination within 90 days of the scan. CT images were obtained and evaluated for body composition analysis by one investigator blinded to clinical data. Images were selected by radiologists at the third lumbar vertebra (L3). Segmentation of tissue cross-sectional areas was conducted according to the following Hounsfield unit thresholds: -29 to 150 for skeletal muscle, -190 to -30 for subcutaneous and intramuscular adipose tissue and -50 to -150 for visceral adipose tissue. Skeletal muscle area (SMA) was normalized for stature to calculate the skeletal muscle index (SMI). Sarcopenia was defined as SMI lower than 41 cm2/m2 in women and 43 cm2/m2 in men with body mass index (BMI) &amp;lt; 25 kg/m2 and &amp;lt; 53 in men with BMI &amp;gt; 25 kg/m2, as described by Martin et al, based on the International Consensus of Sarcopenia. Visceral obesity was defined as visceral fat area &amp;gt; 130 cm2. Diagnosis and classification of CKD were based on the Kidney Disease Improving Global Outcomes criteria and the glomerular filtration rate was estimated from the serum creatinine levels using the CKD Epidemiology Collaboration equation. Results Out of the 521 non-dialysis CKD patients referred to the nephrology clinic, 43 patients met the inclusion criteria. Mean age was 71.0 ± 14.6 years, 55.8% were male and 97.7% were caucasian. The mean follow-up time was 4.3 ± 2.3 years. Most patients had CKD stages 3 to 5 (67.4%) and the mean GFR was 45.4 ± 32.6 ml/min/1.73m2. In our entire cohort, 16 patients were sarcopenic (37.3%; median age: 77.5 years; 9 female and 7 male) and a high prevalence of sarcopenia was observed in stages 3 and 4 of CKD (54,5% and 50%, respectively). There was a non-significant difference in age (77.5 vs. 68, p=0.068), comparing with patients without sarcopenia. The group of the sarcopenic patients had lower BMI (24.4 vs. 28.4 Kg/m2, p=0.008) and height (65.9 vs. 77.6, p=0.01), although BMI &amp;gt; 30 Kg/m2 (1 vs. 9, p=0.052) and visceral obesity (7 vs. 19, p=0.084) were not significantly different between the two groups. Moreover, we observed that patients with sarcopenia tended to have lower albumin levels (2.9 vs. 3.7, p=0.034) and higher LDL levels (135 vs. 67.5, p=0.04). Regarding mortality, 18 patients (41,9%) died during follow-up and the frequency of sarcopenia was significantly higher among non-survivors (68.8% vs. 25.9%, p=0.006). In the univariate logistic regression, for every decrease of one unit in the SMI, mortality increased by 10% (p=0.012). Conclusion Sarcopenia is common in patients with non-dialysis dependent CKD, particularly in advanced stages, and is strongly associated with mortality in this population. Our study highlights the importance of early diagnosis and implementation of therapeutic strategies to minimize the adverse outcomes in CKD patients.

STAGES OF DEVELOPMENT OF RENAL DYSFUNCTION AND ANEMIA IN PATIENTS WITH CHRONIC HEART FAILURE

Chronic heart failure (CHF) accompanies and is the outcome of most cardiovascular diseases, remaining the same One of the main reasons for the high level of disability and mortality of patients. Increasing heart failure over time exceeds the danger to the patient's life of the disease that caused heart failure. The prognosis and outcome of CHF is greatly influenced by kidney function. Renal failure is considered as a predictor of survival in patients with left ventricular dysfunction. Currently, the diagnosis of renal dysfunction in patients with CHF is based on the determination of concentration Serum creatinine, glomerular filtration rate (GFR), and/or the presence of micro albuminuria (MAU) or macro albuminuria.At the same time, the question of tubular function and the daily profile of renal function (daily filtration rate) in patients with CHF remain insufficiently studied. Anemia associated with CHF continues to attract the attention of researchers. This is the purpose of this work.

Glomerular filtration rate changes in the first week of healthy full-term newborns

Background Renal function − as many other organ functions − is immature in the early neonatal period. Aim A prospective study was carried out that aimed at determining serum creatinine and glomerular filtration rate (GFR) in apparently healthy full-term newborns (NBs) on the first and seventh days of postnatal life. Participants and methods This study included 50 apparently healthy full-term neonates born to healthy mothers at Damanhour Medical Institute in AL-Behera governorate. Half of the neonates were males; 27 babies were delivered vaginally and the remaining by cesarian section. All NBs were subjected to a full assessment of history and clinical examination. Complete blood count, C-reactive protein, alanine transaminase, aspartate transaminase, and abdominal ultrasound were performed for all NBs. Serum creatinine and GFR were estimated on the first and seventh days of life. Maternal serum creatinine was determined for all mothers on day 1. Results Serum creatinine showed a significant decrease on the seventh day. GFR was significantly increased by the seventh day of life. NBs’ serum creatinine showed a negative correlation with the postnatal age, while GFR showed a positive correlation.

A highly selective colorimetric assay for the determination of creatinine in biological samples using gluconic acid capped silver nanoparticles after ionic liquid based dispersive liquid phase microextraction

A dispersive liquid-phase microextraction method combined with UV–vis spectrophotometry was utilized to highly selective determination of creatinine in human serum and urine samples. To overcome the interferences in complex matrices, creatinine reacted with 1,4-naphthoquinone-2- potassium sulfonate reagent to produce a red coloured product that could be extracted into a small volume of 1-hexyl-3-methylimidazolium hexafluorophosphate ([HMIM]PF6) ionic liquid solvent. To increase the sensitivity of the assay, gluconic acid capped silver nanoparticles (Ag NPs) were used. On addition of Ag NPs to the red coloured extracted product, the solution turned to blue accompanied with a red shift in wavelength around 620 nm that could be detected by the naked eye. The effective variables on the determination of creatinine such as concentration of the reagent, amount of formic and hydrochloric acids, type and volume of the extractant, and concentration of Ag NPs were investigated. Under the optimal conditions, the calibration plot was bimodal with linear ranges from 0.1 to 1.5 µg mL−1 and 1.5 to 105 µg mL−1 creatinine with a limit of detection 0.1 µg mL−1. The relative standard deviation for five measurements at 35 µg mL−1 concentration level was 3.8%. The newly developed assay was used for the determination of creatinine in human serum and urine specimens with satisfactory results.

Chronic Kidney Disease and Associated Factors Among HIV Infected Patients Taking Tenofovir Disoproxil Fumarate Based Regimen in Ethiopia: A Hospital-Based Cross-Sectional Study.

BackgroundLife expectancy of HIV patients has increased by the extensive use of antiretroviral therapies (ART), but ART predisposes patients to chronic non-communicable diseases including chronic kidney disease (CKD). Tenofovir disoproxil fumarate is one of the commonly used drugs in ART and is found to have more risk for developing CKD. In the study areas, there was no previous study addressing the prevalence of CKD, so the purpose of this study was to pinpoint the prevalence of CKD, and its associated factors.MethodsA hospital-based cross-sectional study was employed at Tikur Anbessa Specialized Hospital (TASH) and Zewuditu Memorial Hospital (ZMH) from April 1 to June 30, 2019. The study participants were proportionally allocated to each hospital and a total of 243 eligible participants were selected conveniently from the two hospitals in the study period. Structured questionnaire and checklist were used to collect socio-demographic and clinical data of the participants. Blood samples (3–5 ml) were used to determine serum creatinine using calibrated fully automated Mind ray BS-200E, and glomerular filtration rate (GFR) was estimated using a chronic kidney disease epidemiology equation. Multivariate logistic regression was employed to identify factors associated with CKD, and a P-value of less than 0.05 was considered significant.ResultsIn the present study, the prevalence of CKD (GFR <60 ml/min/1.73 m2) was 4.53% (95% CI = 2.3–8%). GFR was classified into stages, stage 5 (GFR <15), stage 4 (15–29.9), stage 3 (30–59.9), stage 2 (60–89.9), and stage 1 (≥90) were 0%, 0.4%, 4.1%, 38.3%, and 57.2%, respectively. In the multivariate logistic regression, age greater than 50 years old, and having cancer were significantly associated with CKD (AOR: 0.22, 95% CI = 0.05–0.88, P = 0.033, and AOR: 18.20, 95% CI = 122–271.77, P = 0.035, respectively).ConclusionChronic kidney disease in HIV-infected patients receiving a TDF-based regimen requires attention. Age >50 years old, and having cancer as comorbidity were significantly associated with chronic kidney disease. Patients should be regularly monitored for early diagnosis and management of chronic kidney disease in a TDF-based regimen.

Polyclonal free light chains in IgA-nephropathy: correlation with clinical and morphological parameters and prognostic significance

BACKGROUND. Mechanisms of the initiation of renal interstitial inflammation and fibrosis caused by immunoglobulin monoclonal free light chains (mFLC) in monoclonal gammopathy are well established. As far as these damage pathways are considered to be universal we hypothesize that polyclonal free light chains (pFLC) could have a similar effect on tubular and interstitial tissue and lead to chronic kidney disease (CKD) progression in primary glomerulopathies. THE AIM of this retrospective study was to analyze the association of pFLC kappa (pFLC-κ) and lambda (pFLC-λ) assessed in serum by Freelite® with clinical and morphological parameters and CKD progression in IgA-nephropathy (IgAN) cohort.PATIENTS AND METHODS. In this retrospective study, we enrolled 24 patients with IgAN proven by kidney biopsy (KBx). pFLC-κ and pFLC-λ levels were assessed in all cases at the time of KBx by Freelite® method (N pFLC-κ=3.3-19.4 mg/l, N pFLC-λ=5.7-26.3 mg/l). The normal κ/λ ratio was the inclusion criterion. In all cases, we determined serum creatinine, estimated glomerular filtration rate by CKD-EPI method (eGFRCKD-EPI), and daily proteinuria. Morphological findings were defined semiquantitatively by light and immunofluorescence microscopy. Oxford MEST-C score was evaluated as well as % of glomerulosclerosis. Correlation between parameters was assessed by Spearman’s coefficient. Cox proportional hazards regression was used to analyze the association of parameters with the progression of CKD estimated as an elevation of serum creatinine ≥25 % from the initial level or the initiation of renal replacement therapy at the end of the follow-up period (median was 28 (7; 37) months).RESULTS. Median of pFLC-κ 30.2 (6.1; 67.5) mg/l, median of pFLC-λ 27.6 (11.1; 92.1) mg/l. Levels of pFLC-κ and pFLC-λ were increased in 66.7 % and 50 % of patients, respectively. eGFR CKD-EPI median was 41 (26; 65) ml/min/1.73m2. Serum creatinine correlates with pFLC-κ (R=0.62, p&lt;0.01) and pFLC-λ (R=0.45, p=0.03). Among morphological parameters pFLC-κ correlates with interstitial inflammation (R=0.47, p=0.02), tubular atrophy (R=0.54, p&lt;0.01), interstitial fibrosis (R=0.44, p=0.03), peritubular capillaritis (R=0.42, p=0.04), T-score (R=0.66, p&lt;0.01) and combined MEST-C score (R=0.45, p=0.03). For pFLC-λ the correlations with tubular atrophy (R=0.45, р=0.03) and Т-score (R=0.56, p&lt;0.01) were shown. In Univariate Cox regression analysis pFLC-κ and pFLC-λ were associated with CKD progression (Exp(ß)=1.053; 95,0 %CI 1.003-1.105; p=0.038 and Exp(ß)= 1.041; 95,0 %CI 1.002-1.082; p=0.038, respectively) CONCLUSION. Polyclonal FLC, mostly pFLC-κ, were associated with tubulointerstitial inflammation and fibrosis in patients with IgAN. Increased levels of either pFLC-κ or λ could be proposed as a predictor of CKD progression in patients with IgAN.

Determination of Zoledronic Acid and Creatinine by Hydrophilic Chromatography

We propose a version of the simultaneous determination of zoledronic acid and creatinine in serum and plasma samples by hydrophilic chromatography (HILIC). Factors affecting the determination of zoledronic acid were found: the composition and concentration of the buffer solution, the nature of the stationary phase, the presence of tartaric acid in the eluent as a complexing agent to prevent the complexation of zoledronic acid with metal ions. We determined the linear concentration ranges for zoledronic acid and creatinine and their limits of detection. The following conditions for chromatographic analysis were found: amide stationary phase; a 5 mM phosphate buffer solution, 2 mM tartaric acid (pH 7.0)/CH3CN; gradient 90–70% of CH3CN.

Discordance in the diagnosis of chronic kidney disease between serum creatinine determination and glomerular filtration rate (calculated by Cockcroft-Gault) in hypertensive and / or diabetic patients in a spray of Araguari-MG

A hipertensão arterial (HA) é um problema de saúde pública mundial e um dos principais fatores de risco para o desenvolvimento da doença renal crônica. A HA pode ser tanto a causa como a conseqüência de uma doença renal. A DRC pode ocorrer em mais de 75% dos hipertensos de qualquer idade (BASTOS, 2010)&#x0D; O Diabetes mellitus (DM) é uma condição que ocorre quando o corpo não fabrica insulina suficiente ou não consegue utilizar de forma adequada quantidades normais de insulina (hormônio que regula a quantidade de glicose no sangue).Os pacientes diabéticos apresentam risco aumentado para DRC e devem ser monitorizados frequentemente para a ocorrência da lesão renal. O acometimento renal pela DM representa a principal complicação microvascular da doença e a maior causa de insuficiência renal terminal em todo o mundo, cursando com morbidade e mortalidade elevadas. O risco de desenvolvimento de nefropatia é de cerca de 30% nos diabéticos tipo 1 e de 20% nos diabéticos tipo 2. (Junior, 2004) O DM é a principal causa de IRC em pacientes ingressando em hemodiálise (HD) nos países desenvolvidos, representando até quase 50% dos novos casos. (BURMEISTER, 2012)&#x0D; O presente trabalho tem por objetivo relatar as vivências no desenvolvimento do tema Metodologia Ativa por meio da utilização do Arco de Charles Maguerez em uma Unidade Básica de Saúde da Família (UBSF) do bairro Miranda em Araguari-MG, durante a disciplina Internato em Sistemas Municipais de Saúde da Unidade de Ensino do Curso de Medicina do Instituto Master de Ensino Presidente Antônio Carlos - IMEPAC.&#x0D; O Arco de Charles Maguerez é uma das estratégias de ensino-aprendizagem para o desenvolvimento da Problematização e partir da realidade social.&#x0D; Durante o estudo e a observação da realidade local foram avaliados 487 prontuários, onde nos deparamos com 149 hipertensos, 68 diabéticos, 270 hipertensos e diabéticos. Identifica - se que não ocorreu a avaliação necessária a estes portadores já que de acordo com os protocolos oficiais de HAS e da Sociedade Brasileira de Nefrologia orientam, a investigação clínica e laboratorial anual com a dosagem da creatinina sérica e o cálculo da TFG com o uso da equação de Cockcroft-Gault. Propõe-se a investigação da não aplicabilidade dos protocolos oficiais&#x0D; Trata-se de um estudo transversal realizado em uma ESF de Araguari-MG. Houveram dois instrumentos de coleta, o primeiro foi a avaliação da Pressão Arterial (PA) realizada um uma reunião de Hipertensos, e o segundo deu-se com a análise do prontuário do grupo de pacientes estudado. Foi considerado como Hipertensão Arterial Sistêmica Controlada níveis menores que 140/90mmhg.

Analysis of the influence of clinical and morphological parameters on the risk of small-diameter renal artery fibroelastosis in arterial hypertension and primary chronic glomerulonephritis

Abstract Introduction The study of remodeling of small-diameter renal arteries in hypertension (AH) and primary chronic glomerulonephritis (CGN) is promising. This is due to the high prevalence of CGN and the likelihood of developing chronic renal failure, as well as insufficient information about the process of remodeling the small arterial wall of the kidneys. Goal To evaluate the influence of clinical and morphological parameters on the risk of small-diameter renal artery fibroelastosis in patients with AH and CGN. Materials and methods The study included 105 patients with AH and CGN. One of the main criteria for inclusion in the study was the presence of indications for performing nephrobiopsy. All subjects underwent a standard clinical and laboratory study, with determination of serum creatinine, of glomerular filtration rate (GFR) (CKD-EPI), detection of daily proteinuria, systolic (SAD) and diastolic blood pressure (DAP), and the degree and stage of AH. That 66 patients had no signs of fibroelastosis of arteries (the first group), and 39 patients had fibroelastosis (the second group). The presence of tubulointerstitial fibrosis (TF) and inflammation (TI), the prevalence of fibrosis were recorded. Results In the first group of patients, the level of SAD, established at the stage of inclusion in the study, was 124.33±21.5mmHg, in the second group – 131.15±17.3mmHg. (p=0.09). DAP values were in the range of 81.97±11.2 and 83.08±9.15mmHg. respectively (p=0.59). When analyzing the degree and stage of AH, statistically significant differences were obtained - 1.29±1.05 and 1.82±0.9 degrees (p=0.009), 1.41±1.08 and 2.08±0.9 stages (p=0.002), respectively. The value of creatinine in the first group was 98.33±39.8mmol/l (1.11 mg/dl), in the second group – 131.49±54.4mmol/l (1.49 mg/dl) (p=0.03), GFR - 97.6±40.4 and 69.3±32.5 ml/min/1.73m2 (p=0.0001), respectively. There were no significant differences in the proteinuria of patients in the study groups (3.64±6.2 and 4.1±5.1 g/l, respectively, p=0.42). Analysis of data obtained during morphological examination allowed us to establish more pronounced changes in TF and TI in the study groups (44 and 35 cases of TF (p=0.009), 35 and 29 cases of TI (p=0.025), respectively, groups). In the first group of patients, the prevalence of TF fever was set at 14.1±19.4%, in the second group – 27.95±21.9% (p=0.001). Conclusions The leading reasons for remodeling the vascular bed of small-diameter kidneys in AH and CGN are hemodynamic factor and tissue changes in the kidneys. The presence of fibrosis and interstitial inflammation is associated not only with the effects of the main CGN process, but also with the presence of AH. Confirmation of this conclusion is obtained differences in the stages of AH. An result of the study is data indicating that there are no differences in the clinical sign of progression of CGN-proteinuria, that is, the main pathogenetic factor of CGN does not affect of remodeling of the arteries. Funding Acknowledgement Type of funding source: None

Chronic Kidney Disease and Associated Factors Among HIV/AIDS Patients on HAART in Ethiopia.

BackgroundIn developing countries, both opportunistic infections and chronic diseases account a high HIV-associated mortality and morbidity. Chronic kidney disease (CKD) associated with HIV infection has got increased attention in sub-Saharan Africa as a result of the high HIV prevalence and due to the late diagnosis and initiation of HAART. Thus, this study was conducted to assess CKD and associated factors among HIV patients on HAART in Ethiopia.MethodsA hospital-based cross-sectional study with a secondary data review was conducted on 336 on HIV/AIDS patients on HAART from February to July 2017 at University of Gondar Referral Hospital. The study participants were selected using a systematic random sampling technique. Socio-demographic and clinical data were collected using a semi-structured questionnaire at their follow-up date with interview and chart review. Three to five milliliters of venous blood and five milliliters of urine specimen were collected for serum creatinine and urine albumin determination, respectively. Data were entered into SPSS version 20 for analysis. Glomerular filtration rate was estimated using the CKD-EPI estimator. Bivariate and multivariate logistic regression was employed and p-value <0.2 and < 0.05, respectively, was considered statistically significant.ResultsThe prevalence of CKD on the study participants was 54 (16.1%) (95% CI, 12.2–20.4%). By stage, about 27 (8.0%) had stage 1 (persistent proteinuria with eGFR ≥ 90 mL/min/1.73 m2), 16 (4.8%) had stage 2 (persistent proteinuria with eGFR of 60–89.9 mL/min/1.73 m2), 6 (1.8%) had stage 3 (eGFR 30–59.9 mL/min/1.73 m2 with or without proteinuria) and 5 (1.5%) had stage 5 ((kidney failure), eGFR<15mL/min/1.73 m2 with or without proteinuria). With multivariate logistic regression analysis, being male (AOR=2.05 (1.03–4.09), p=0.04), being merchant (AOR=2.91 (1.00–8.48), p=0.049) and having viral load≥1000 copies/mm3 (AOR=3.1 (1.38–7.00), P<0.01) were significantly associated with CKD.ConclusionThe prevalence of CKD among HIV patients on HARRT is high. Being male, merchant and having viral load ≥1000 copies/mm3 were associated factors of CKD. Patients should be regularly monitored and screened for early diagnosis and management of CKD. Those patients who have being merchant with high viral load and male patients should require close monitoring.

From the bottom of an old jar: A fluorometric method for the determination of creatinine in human serum

In this paper we have investigated and optimized a non-enzymatic fluorometric creatinine assay. The method was originally described by Blass in the 90s, but we found that besides the reagents mentioned in the paper, an addition of hydrogen peroxide is required to obtain a fluorescent compound. The excitation and emission maxima of the fluorophore are 405 nm and 475 nm, respectively. The optimal conditions for creatinine quantification are as follows: 25 mmol L−1 3,5-dinitrobenzoic acid dissolved in 1,4-butanediol with 58 mmol L−1 H2O2 and aqueous solution of 2 mol L−1 NaOH mixed in 1:1 ratio. A linear calibration curve (y = 18,7x + 446 for 300 s of incubation) was obtained in the range from 2.6 to 750 μmol L−1 of creatinine with LOD and LOQ equal to 0.7 and 2.6 μmol L−1, respectively. The method was found to be selective towards the analyte in the presence of compounds such as urea, uric acid, bilirubin, albumin and glucose. The developed protocol was applied for creatinine determination in 13 real human serum samples. A correlation (y = (0.94 ± 0.03) x + (3.66 ± 3.22) with Pearson’s r 0.996) and statistical agreement (two-tailed Student’s t-test at 95% confidence interval with 12 degrees of freedom) was reached between the obtained results and the reference enzymatic method.

Problems of quantitative estimation of excretory kidney function based on creatinin

This review presents the possibility of using serum creatinine as an endogenous indicator of the functional state of the kidneys. The results of scientific research are analyzed, which shows the information content of the use of this indicator for assessing glomerular filtration rate (GFR). The features of laboratory methods for determining serum creatinine are considered. Particular attention is paid to information about the errors and variability of measurements of standardized methods obtained in laboratories of different countries. In addition to the physiological reasons that make serum creatinine an imperfect marker for GFR, there are analytical measurement errors, which, in turn, can also distort true results. Since the relationship between serum creatinine and GFR is hyperbolic, analytical errors will affect not only the accuracy of the calculation equations based on it. The introduction of standardization of routine methods for measuring serum creatinine from a reference sample improved the assessment of GFR by reducing the bias of the results of measuring creatinine from its true value. To increase the accuracy and reliability of standardized methods, it is necessary to continue research in this direction. In real clinical practice, all the limitations and assumptions of a specific method of measuring creatinine should be taken into account in order to avoid incorrect interpretation of the results when assessing the functional ability and staging of chronic kidney disease. For prospective observation of a specific patient, the same GFR calculation formula and the same method for measuring serum creatinine should be used.

P0808DEFINING CRITERIA FOR CKD STAGE 3 PATIENTS NEPHROLOGY REFERRAL: AN ANALYSIS FOCUSED ON CKD PROGRESSION AND MORTALITY RISK

Abstract Background and Aims The high prevalence of CKD and its increasing awareness by primary care clinicians is posing a huge burden over health care systems, especially over Nephrology departments. While the referral of CKD stage 4 and 5 to a nephrology clinic is undisputable, the need for stage 3 patients referral is still subject to debate. Our objective was to investigate baseline characteristics of CKD stage 3 patients associated with subsequent CKD progression, in order to help determine which patients should be referred at this stage. Additionally, we investigated the association of CKD stage 3 progression with morbidity and overall mortality. Method We conducted a patient-level, retrospective, cohort analysis of all patients referred to a nephrology clinic over a 6 years period. We included CKD stage 3 patients with at least 36 months of follow-up or 24 to 36 months of follow up with more than 3 serum creatinine determinations. CKD progression was defined by one of the following: 1) an eGFR (CKD-EPI) decline superior to 5mL/min/year; 2) Serum creatinine duplication; 3) The need for chronic RRT. Baseline covariates included demographics, comorbid conditions and laboratory values. Univariate and multivariate analysis were employed to determine independent predictors of CKD progression and mortality. Results Out of the 3008 patients referred to the nephrology clinic, 1288 (42.8%) were CKD stage 3 patients and from these, 594 (19.8%) met the inclusion criteria (median age: 71.9 years; 63.8% male). Median follow-up was 4.9 years (IQR 2.2). 133 (22.4%) met the criteria for CKD progression and 110 (18.6%) died. In univariate analysis, CKD progression was associated with higher proteinuria (405.7 vs 65.5mg/gr, p&amp;lt;0.001), Diabetes (60.9 vs 45.3%, p=0.002), Congestive heart failure (CHF) (40.6 vs 28.7%, p=0.009), Anemia (OMS definition) (68.0 vs 44.7%, p&amp;lt;0.001), higher diuretic use (48.9 vs 34.1%, p=0.002) and higher mortality (40.9 vs 12.2%, p&amp;lt;0.001) In multivariate logistic regression analysis, albuminuria over 300 mg/gr [Odds ratio (OR) 3.57, 95% CI 2.20 - 5.80, p&amp;lt;0.001] and Anemia (OR 1.97, 95% CI 1.20 – 3.22, p=0.007) were associated with CKD progression. The possible association with other variables was not confirmed. The independent predictors of mortality were: CKD progression (OR 4.49, 95% CI 2.69-7.50, p=&amp;lt;0.001), Older age (OR per 1 year increase 1.03, 95% CI 1.01-1.05, p=0.003), presence of CHF (OR 1.75, 95% CI 1.03-2.98, p=&amp;lt;0.037), presence of Hyperkalemia at first consultation (OR 2.12, 95% CI 1.00 – 4.52, p=0.049) and Anemia (OR 1.93, 95% CI 1.03 - 3.62, p=0.025). Higher body mass index was associated with a lower risk of mortality (OR 0.58, 95% CI 0.35 – 0.95, p=0.033) Conclusion Our study suggests that patients with macroalbuminuria and anemia at first consultation are at increased risk for rapid CKD stage 3 progression. In this group, patients with CHF, anemia and hyperkalemia (even at first consultation) have a higher risk of mortality. This study may be useful and help us in guiding which CKD stage 3 patients should be referred to a nephrology clinic.

EFECTO DEL EJERCICIO AGUDO SOBRE LA FILTRACIÓN GLOMERULAR DE ADULTOS MAYORES

Introducción: Existe una disminución de la Filtración Glomerular (FG) en adultos mayores y la práctica del ejercicio puede causar cambios en la función renal. Objetivo: Evaluar el efecto de diferentes intensidades de ejercicio agudo sobre la filtración glomerular en adultos mayores. Método: 20 adultos mayores aparentemente sanos de 69,8 ± 4 años realizaron 3 pruebas de ejercicio físico: máxima y 2 sub-máximas (80% y 60%). Se colectaron muestras de sangre venosa para estimar la filtración glomerular por creatinina, antes y después del ejercicio. Resultados: Se observó una disminución significativa post-ejercicio en la filtración glomerular, estimada a partir de creatinina sérica en las pruebas máxima y sub-máxima a 80% (p &lt; 0,05). Conclusión: El ejercicio físico agudo máximo y sub-máximo al 80% de intensidad en adultos mayores aparentemente sanos, provoca una disminución de la filtración glomerular.

Evaluation of serum metabolic parameters as predictors of bovine respiratory disease events in high-risk beef stocker calves

The primary objective of this study was to evaluate the association between serum metabolic parameters and the risk of bovine respiratory disease (BRD) in high-risk beef stocker calves. Jugular venous blood samples were collected from mixed-breed beef bull, steer, and heifer calves (n=468) at the time of arrival processing at a stocker facility in northeast Georgia. Serum samples were then submitted for determination of serum creatinine, total calcium, phosphorus, magnesium, albumin, serum urea nitrogen, glucose, cholesterol, beta-hydroxybutyrate (BHBA), non-esterified fatty acid (NEFA), sodium, potassium, and chloride concentrations, as well as sodium:potassium ratio and NEFA:cholesterol ratio. Calves were monitored for the development of signs consistent with BRD for 45 days following arrival. A multi-variable logistic regression model was created to evaluate the association between serum variables and subsequent risk of BRD. In this analysis, BRD was associated with higher serum potassium, lower serum urea nitrogen, and lower BHBA concentrations at arrival processing. The area under the receiver operating characteristic curve for the ability of the model to predict morbidity was 0.645. These data suggest that hydration status, nutrient balance, and degree of rumen development may play a role in the development of BRD in high-risk beef stocker calves.