Difference In Creatinine Values Research Articles

Estimating baseline kidney function in hospitalized adults with acute kidney injury

AimBaseline serum creatinine values are required to diagnose acute kidney injury but are often unavailable. We evaluated four conventional equations to estimate creatinine. We then developed and validated a new equation corrected by age and gender.MethodsWe retrospectively examined adults who, at first hospital admission, had available baseline creatinine data and developed acute kidney injury ≥24 h after admission. We split the study population: 50% (derivation) to develop a new linear equation and 50% (validation) to compare against conventional equations for bias, precision, and accuracy. We stratified analyses by age and gender.ResultsWe studied 3139 hospitalized adults (58% male, median age 71). Conventional equations performed poorly in bias and accuracy in patients aged <60 or ≥75 (68% of the study population). The new linear equation had less bias and more accuracy. There were no clinically significant differences in precision. The median (95% confidence interval) difference in creatinine values estimated via the new equation minus measured baselines was 0.9 (−3.0, 5.9) and −0.5 (−7.0, 3.7) μmol/L in female patients 18–60 and 75–100, and −1.5 (−4.2, 2.2) and −7.8 (−12.7, −3.6) μmol/L in male patients 18–60 and 75–100, respectively. The new equation improved reclassification of KDIGO AKI stages compared to the MDRD II equation by 5.0%.ConclusionEquations adjusted for age and gender are less biased and more accurate than unadjusted equations. Our new equation performed well in terms of bias, precision, accuracy, and reclassification.

Effectiveness of boiled Comfrey Leaf (Symphytum Officinale L) on Ureum Creatinine Serum in Male Wistar Strain of Acute Kidney Failure model.

Acute kidney failure is a decrease in kidney that occurs only in a matter of hours even days which can be seen from decreased urine production and increased blood urea nitrogen and creatinine. This study aims to determine the effectiveness of boiled comfrey leaf (symphytum officinale L) on Ureum Creatinine Serum in Male Wistar Strain of Acute Kidney Failure model. This research used 30 male Wistar strain rats weighing 180-200 grams and aged 2-3 months that were divided into 3 groups, namely negative group (only given minerals), positive group (kidney damaged by gentamicin 0.3cc IP / day) and the treatment group (the kidneys were damaged with gentamicin 0.3cc IP / day and 2.8 g of boiled comfrey leaf in 150 cc of water and 2.7 cc were given orally for 7 days). Data were analyzed with SPSS version 24, one way ANOVA test was performed to compare the levels of ureum and creatinine. The results showed that there was a significant difference in the ureum of the treatment group and the positive group (p &lt;0.05) but there was no significant difference in the ureum value between the treatment group and the negative group. There was a significant difference in creatinine values between the treatment group, positive group and negative group (p &lt;0.05). As a Conclusion boiled comfrey leaf (symphytum officinale L) water has an effect on decreasing serum levels of ureum creatinine in male rats wistar strain of acute kidney failure model.

Malignant ureteral obstruction: experience and comparative analysis of metallic versus ordinary polymer ureteral stents

BackgroundTo study the outcome and experience of using metallic stents in treating patients with malignant ureteral obstruction (MUO).MethodsSeventy-six patients with MUO were assigned to the metallic stent group (MSG) or the ordinary polymer stent group (OPSG) according to the different materials. The success rate of the operation, duration of operation, patency rate serum creatinine values ,postoperative complications and QOL scores were compared between the two groups.ResultsIn the OPSG and MSG, the success rates of the operation were 95.5% and 96.9%, respectively, and the durations of the operation were 20.6 ± 2.2 min and 50.9 ± 10.3 min (P < 0.01), respectively. There was no significant difference between the groups in serum creatinine values at 3 days after the operation (P > 0.05); however, the creatinine values at 3 days after the operation decreased significantly compared with those before the operation (P < 0.01). In the OPSG, there was no significant difference in creatinine values between 3 days and 6 months after operation, while the creatinine values 1 year after operation were increased significantly compared to those at 3 days after the operation (P < 0.05). In the MSG, there was no significant difference among creatinine values at different intervals (P > 0.05). The total rate of post-procedural complication was lower in the MSG than that in the OPSG(P < 0.05). There was no significant difference in the QOL score between the two groups before the operation (P > 0.05); however, the QOL scores at 6 months and 1 year after the operation were higher in the MSG than that in the OPSG(P < 0.05). In the MSG, there was no significant difference in the QOL score between preoperation and 6 months after surgery. Similarly, there was also no difference in the QOL score between 6 months after surgery and 1 year after surgery(P > 0.05). On the contrary, the differences of QOL score in the OPSG group were much significant between disparate time intervals (P < 0.05).ConclusionsFor patients with MUO who require long-term retention of the stent, metallic stents with longer indwelling time are superior to ordinary polymeric stents.

Cortisol y Creatinina en el líquido amniótico

Se realizó la determinación de creatinina y cortisol libre en el líquido amniótico en 150 pacientes del Hospital General Base Cayetano Heredia, de las cuales 117 eran gestantes sin trabajo de parto, 21 en trabajo de parto y 12 cesáreas programadas sin trabajo de parto. En las gestantes sin trabajo de parto (31- 42 semanas) las determinaciones de cortisol variaron sin significado estadístico; los valores de creatinina se elevan significativamente entre las 36 - 37 semanas. Durante el trabajo de parto los valores de cortisol se incrementan con significación estadística, comparados con los obtenidos en las pacientes cesareadas sin trabajo de parto; no hay diferencia en los valores de creatinina.

Interference of Bilirubin in Creatinine Value Measurement by Jaffe Kinetic Method

BACKGROUND: Creatinine measurement in icteric sample is a major but unresolved problem. Bilirubin causes negative interference in creatinine value measurement using general techniques. The objective of this study was to find differences in creatinine value by Jaffe Kinetic method pre-incubation and without pre-incubation with NaOH. METHODS: This was a cross sectional, descriptive study carried out in 71 samples with different level of bilirubin concentration. We took blood samples of 71 different patients, 48 males and 23 females, from two different hospitals of Kathmandu village. Both creatinine and bilirubin concentration in serum samples were measured by using Staxfax 3300 semi auto analyzer in the hospital. In the laboratory creatinine value was measured by kinetic method and bilirubin measured by Jendrassik/ Grof method using commercial kits. Statistical analysis of quantitative data was done by using SPSS version 16.0. RESULTS: The results shows differences in creatinine values with respect to methods and extent of bilirubin concentration. It was found that the creatinine obtained by pre-incubation with NaOH has greater value than without pre-incubation (i.e. by direct estimation using working reagent). It was also shown that the high bilirubin cause the interference in greater extent. The significant interference was seen in the sample with bilirubin concentration greater than 20 mg/dl i.e. creatinine value after treatment with NaOH prior to dispensing picric acid is significantly increases, P&lt;0.01 at 99% confidence level. CONCLUSION: This shows that the bilirubin has negative interference in creatinine value measurement by ordinary laboratory practices and interference increases with higher concentration of bilirubin in blood sample. DOI: http://dx.doi.org/10.3126/acclm.v1i1.12311 Ann. Clin. Chem. &amp; Lab. Med. 1(1) 2015: 25-28

Renal Effects of Combination Infusion of High Dose Furosemide and Nesiritide in Patients with Acutely Decompensated Heart Failure

Background: Limited and conflicting data exist on renal effects of combined therapy with Furosemide and Nesiritide infusions in pts with acute decompensated heart falure (ADHF). Methods: We examined data on 45 consecutive pts who were admitted with ADHF who received combination Nesiritide infusion at 0.01 mcg/kg/min and Furosemide infusion at 5–10 mg/hr for at least 12 hrs. Pts with stage V chronic kidney disease or on dialysis as well as patients who received the combination treatment post-cardiac surgery were excluded. Data were reviewed retrospectively. Results: Out of 45 patients, 20 (44.4%) were female and 40 (89%) were black. Average age was 54.4 years (17). Mean EF was 19% (11). Most patients (84%) had some degree of renal dysfunction on admission, ranging from mildly to severely reduced glomerular filtration rate (GFR). Average time on combination therapy was 34 hours (±15). During combination treatment,mean diuresis was 4547 ml (±2976) and average wt loss was 9.4 lbs (±8.5). Mean BUN was 22(±9)mg/dl on admission and 26 mg/dl (±13)mg/dl upon discharge (p=0.01). Mean creatinine of was 1.3 mg/dl (±0.4) mg/dl on admission and 1.4 (±0.5) mg/dl upon discharge (p=0.36). Mean GFR was 62 (±22) ml/min/m2 on admission and 59 (±24) ml/min/m2upon discharge (p=0.17). Only 4 pts (9%) experienced worsening renal function (WRF) as defined by increase in serum creatinine of >0.5 mg/dl between admission and discharge or increase in serum creatinine of >0.3 mg/dl during the hospitalization to a level >1.5 mg/dl at discharge. None of the pts required acute dialysis during the index hospitalization and the highest degree of creatinine elevation was 0.8 mg/dl from baseline. There were no deaths during the index hospitalization.Figure 1: Difference in Creatinine Values (mg/dl) of the 45 Patients Between Admission and DischargeConclusion: Combined therapy of continous high dose Furosemide and Nesiritide infusions is not associated with WRF, and the degree of creatinine elevation is generally mild. The combination therapy is effective and useful in achieving large volume diuresis with minimal renal consequences.

Plasma cystatin C determinations in a healthy elderly population

Plasma cystatin C measurement has been previously shown to be a better indicator of changes in glomerular filtration rate (GFR) than plasma creatinine. The available literature on reference intervals for cystatin C concentration encompasses only paediatric and adult populations up to 60 years of age, therefore we set out to determine an elderly reference range. Blood was taken from 401 subjects (65–101 years) and cystatin C and creatinine concentrations measured using commercially available methodologies. The availability of height and weight measurements allowed the additional calculation of predicted creatinine clearances using the Cockcroft and Gault formulae. Whilst no notable gender difference in cystatin C values was observed (female, 1.48 mg/l; male, 1.53 mg/l), concentrations rose with increasing age (60–79 years, 1.39 mg/l; >80 years, 1.70 mg/l). Conversely, there was a significant ( P<0.0001) gender difference in creatinine values (female, 99 μmol/l; male, 120 μmol/l) but none between age groups (60–79 years, 105 μmol/l; >80 years, 113 μmol/l). Calculated GFR determinations resulted in a predicted creatinine clearance range of 21–81 ml/min per 1.73 m 2 ( n=361). There was no significant difference between gender (male, 18–88 ml/min per 1.73 m 2; female, 24–69 ml/min per 1.73 m 2), but a very significant 20% decrease in predicted GFR per decade. Sex-related reference intervals for creatinine were established (female, 66–149 μmol/l; male, 71–204 μmol/l); whilst age-related reference intervals were established for both cystatin C (60–79 years, 0.93–2.68 mg/l; >80 years, 1.07–3.35 mg/l) and predicted creatinine clearance (60–79 years, 27–89 ml/min per 1.73 m 2; >80 years=18–55 ml/min per 1.73 m 2). Plasma cystatin C measurement offers a simple, more sensitive screening assay for early changes in GFR and reflects the decreasing GFR that occurs with increasing age.

Descending thoracic aorta aneurysmectomy: left-left centrifugal pump versus simple clamping technique

Forty-six patients who had had an elective repair of a descending thoracic aortic aneurysm were reviewed, in order to investigate the efficacy of support by a centrifugal pump on distal organ perfusion and spinal cord protection during cross-clamping of the thoracic aorta. Two concurrent groups were analysed: 36 patients (78%) were supported by left atriofemoral arterial bypass with a centrifugal pump and 10 (22%) had no distal circulatory support. No patient was fully heparinized. The demographic data and preoperative characteristics of the groups, including location and type of aneurysrn, were similar. The mean(s.d.) duration of cross-clamping was 37.8(16) min in the centrifugal pump group and 42.3(21) min in the simple clamping group. Preoperative haemodynamic and laboratory data were similar in both groups. During cross-clamping, parameters of pH and blood urea varied but were better in the centrifugal pump group; changes from pre-intervention to early aortic cross-clamping time were not significant (pH, P<0.0006; bases, P<0.0003). Differences in creatinine values were caused mainly by the change from pre-intervention to the first postoperative day ( P<0.03); this continued throughout the hospital stay. The cerebrospinal fluid pressure measurement indicated a significant difference in time change ( P<0.0001) and mean level over time ( P<0.0002): levels were significantly lower in the centrifugal pump group throughout aortic cross-clamping. Three patients in the simple clamping group and none in the centrifugal pump group ( P<0.02) required cerebrospinal fluid drainage. Paraplegia occurred in one patient (3%) in the centrifugal pump group and in one (10%) in the simple clamping group ( P = n.s.). The overall in-hospital mortality rate was 9%, with 71% of all deaths occurring in patients who had an emergency repair of the aneurysrn. The cumulative 5-year survival rate was 72% in the centrifugal pump group and 84% in the simple clamp group ( P = n.s.). The results confirm that patients offered centrifugal pump support are better stabilized metabolically, suggesting that spinal cord perfusion is improved.