Elevated Serum Creatinine Levels Research Articles

Typical and Atypical Manifestation of Scrub Typhus in Children

Introduction: Scrub typhus is grossly under-diagnosed or lately diagnosed in India because of its non-specific clinical presentation, a limited awareness about the disease, a low index of suspicion among clinicians, and a lack of diagnostic facilities. Absence of typical features may create diagnostic dilema among physicians thereby delaying the diagnosis which may lead to complications & high mortality. Material and method: A hospital based Cross sectional study which was conducted in the Department of Paediatrics, PRM Medical College, Baripada, Odisha from July 2021 to December 2021. Children from 1 month to 14 years of age presenting with fever in whom rickettsia infection is suspected included. All children who are found to be Elisa or IgM positive for scrub typhus even if admitted for other disease included. All fever cases with rash /oedema/ pallor/icterus/lymphadenopathy/hepatosplenomegaly and or any other systemic features with or without eschar was included. Results: The laboratory parameters of the cases are shown in Table 4. The total leukocyte count was elevated in 30.6% of the cases. An elevated serum creatinine level or a change in the serum creatinine level greater than 0.3 mg/dl, which is a diagnostic of AKI, was observed in 20% of cases. Hyponatremia was found in 6.9% of the cases. The serum CPK level (total and MB fraction) was elevated in 8.9% of cases. Conclusion: Pediatric scrub typhus is a common infection and should be suspected in cases with fever for more than 5 days and non-specific signs and symptoms. Early detection and timely management lead to a higher recovery rate. Hypotension, hypoxia, azotemia, altered sensorium, and bleeding manifestations on admission were associated with unfavorable outcomes.

Different pharmacokinetics of lithium orotate inform why it is more potent, effective, and less toxic than lithium carbonate in a mouse model of mania

Lithium carbonate (LiCO) is a mainstay therapeutic for the prevention of mood-episode recurrences in bipolar disorder (BD). Unfortunately, its narrow therapeutic index is associated with complications that may lead to treatment non-compliance. Intriguingly, lithium orotate (LiOr) is suggested to possess unique uptake characteristics that would allow for reduced dosing and mitigation of toxicity concerns. We hypothesized that due to differences in pharmacokinetics, LiOr is more potent with reduced adverse effects. Dose responses were established for LiOr and LiCO in male and female mice using an amphetamine-induced hyperlocomotion (AIH) model; AIH captures manic elements of BD and is sensitive to a dose-dependent lithium blockade. LiCO induced a partial block of AIH at doses of 15 mg/kg in males and 20 mg/kg in females. In contrast, LiOr elicited a near complete blockade at concentrations of just 1.5 mg/kg in both sexes, indicating improved efficacy and potency. Prior application of organic anion transport inhibitors, or inhibition of orotate uptake into the pentose pathway, completely blocked the effects of LiOr on AIH while sparing LiCO effects, confirming differences in transport and compartmentalization between the two compounds. Next, the relative toxicities of LiOr and LiCO were contrasted after 14 consecutive daily administrations. LiCO, but not LiOr, elicited polydipsia in both sexes, elevated serum creatinine levels in males, and increased serum TSH expression in females. LiOr demonstrates superior efficacy, potency, and tolerability to LiCO in both male and female mice because of select transport-mediated uptake and pentose pathway incorporation.

#4208 CRP EXACERBATES SARS-COV-2-NUCLEOCAPSID PROTEIN-INDUCED ACUTE KIDNEY INJURY

Abstract Background and Aims COVID-19, caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2), is a progressive viral pneumonia with a broad spectrum of clinical manifestations involving multiple organs. Acute kidney injury (AKI) is common in COVID-19, especially the critically ill patients. Our previous study proved that kidney-specifically overexpressing SARS-CoV-2 N protein induces AKI, which become worsen in mice under ischemic condition. Clinically, CRP is a risk factor for AKI in COVID-19 patients. Recent clinical study showed that CRP Apheresis is able to effectively remove the plasma CRP and thus improve the clinical outcome in critically ill COVID-19 patients. We thus hypothesize that CRP may not only be a biomarker or risk factor, but also a potential mediator or novel therapeutic target for COVID-19 AKI. Method The role of CRP in COVID-19 AKI was investigated in a mouse model of AKI induced by ultrasound-microbubble-mediated kidney-specifically transferring SARS-CoV-2 N-expressing plasmids in CRP wide-type (WT) and Transgenic (Tg) mice. We also developed a novel therapy for SARS-CoV-2 N-induced by targeting CRP signaling with a neutralizing anti-CD32 antibody both in vivo and in vitro. Results In COVID-19 patients with AKI, serum levels of CRP were significantly elevated when compared with non-AKI group. In mice, kidney-specifically overexpressing SARS-CoV-2 N protein caused AKI including tubular necrosis and elevated levels of serum creatinine and BUN in CRP WT mice, which became more severe in CRP Tg mice. Importantly, targeting CRP-CD32 signaling with a neutralizing antibody to CD32 significantly inhibited SARS-CoV-2 N protein-induced AKI in CRP Tg mice. Mechanistically, we uncovered that CRP promoted SARS-CoV-2-N protein-induced AKI via the Smad3-p21-dependent G1 cell cycle arrest and NF-κB/p-p65-driven renal inflammation, which was blocked by anti-CD32 antibody in vivo and in vitro. Conclusion CRP is not only a biomarker or risk factor, but also a mediator in SARS-CoV-2 N protein-induced AKI. CRP signals through CD32 mediate SARS-CoV-2 N-induced AKI via mechanisms associated with the Smad3-p21-dependent G1 cell-cycle arrest and NF-κB/p-p65-driven renal inflammation. Targeting CRP-CD32 signaling may represent as a novel therapy for COVID-19-associated AKI.

#5050 ANTIOXIDANT PORPHYRIN-BASED NANOZYME WITH SINGLE RUTHENIUM FOR TREATMENT OF ACUTE KIDNEY INJURY

Abstract Background and Aims Acute kidney injury (AKI) describes a sudden loss of kidney function characterized by elevated serum creatinine (CRE) levels and reduced urinary output. AKI patients have a high mortality rate, but limited treatment options are currently available. During the AKI progression, an excess of reactive oxygen species (ROS) leads to oxidative stress, which often results in cell damage and renal failure. Therefore, ROS scavenging has been considered a promising strategy for AKI treatment. Here we report a porphyrin-based nanozyme with single ruthenium (Por-Ru) as a ROS scavenger to cure AKI. Method The Por-Ru nanozyme was synthesised by one-pot synthesis. First, the 5,10,15,20-tetra(4-pyridyl)-21H,23H-porphine (Por) was added to the solvent containing N, N-dimethylformamide. The RuCl3 was then introduced to form Ru-N coordinated porphyrin networks. We analysed the morphology and chemical structure using scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS). We also tested its enzyme-mimicking abilities to scavenge ROS. The catalase-like (CAT) property was tested using a peroxide-titanium complex method, and the superoxide dismutase-like (SOD) property was tested using a •O2− scavenging assay. In vitro, the protective effect of Por-Ru nanozyme against ROS damage was examined using the mouse tubular epithelial (TCMK-1) cell line. After biocompatibility evaluation, the therapeutic efficacy of Por-Ru nanozyme was investigated in glycerol-induced AKI mice. Results 1. Characterizations of Por-Ru nanozyme: The SEM image showed the Por-Ru nanozyme was spherical with an average diameter of 6-8 nm (Figure 1a). Meanwhile, the XPS revealed the presence of Ru and showed the detailed elemental components (Figure 1b). As shown in Figures 1c and d, the Por-Ru nanozyme had excellent CAT-like and SOD-like capabilities. Furthermore, the DPPH• assay confirmed the antioxidant property (Figure 1e). 2. Protective effect of Por-Ru nanozyme in vitro and in vivo: The results of cell counting kit-8 assay showed that Por-Ru nanozyme was not cytotoxic to TCMK-1 cells at concentrations ranging from 10 to 100 µg/mL. We further examined the cytoprotective effects of Por-Ru nanozyme against ROS damage. The flow cytometry results showed that the intracellular ROS level increased after treatment with H2O2, while the ROS level obviously decreased with the addition of Por-Ru nanozyme (Figure 2a, b). The protective effect of Por-Ru nanozyme against H2O2-induced apoptosis was also investigated. As shown in Figures 2c and d, the rate of cell apoptosis was significantly reduced with the addition of Por-Ru nanozyme. Before the in vivo experiments, the haemolysis rate of Por-Ru nanozyme was examined and found to be less than 5% even at a dose of 200 µg/mL. Additionally, the in vivo toxicity assessment showed that Por-Ru nanozyme at test concentrations had no noticeable impacts on blood parameters, liver and kidney functions, and histopathology of major organs in normal mice. Then, we tested the therapeutic effect of Por-Ru nanozyme in AKI mice. As shown in Figures 2e and f, the CRE and blood urea nitrogen (BUN) levels of AKI mice treated with Por-Ru nanozyme were significantly lower than those of AKI mice group. Additionally, the results of haematoxylin and eosin (H&E) staining showed that many casts (marked as triangles) were observed in the kidney tissue of AKI mice, whereas no obvious damage area was found in AKI mice after the treatment of Por-Ru nanozyme. Conclusion Our findings demonstrate that the Por-Ru nanozyme has excellent anti-ROS enzyme-mimicking capabilities. In vitro experiments revealed that Por-Ru nanozyme alleviated ROS-induced cell apoptosis. In AKI mice, Por-Ru nanozyme effectively improved renal function and attenuated renal tissue damage. Taken together, Por-Ru nanozyme may become a novel agent for AKI treatment.

Immunoglobulin A nephropathy in remission: a case report.

A 33-year-old military male presented with complaints of fever, headache, myalgia, chills, and haematuria for 10 years. His lab results showed elevated serum creatinine levels and proteinuria. A renal biopsy was done which was consistent with a diagnosis of immunoglobulin A nephropathy. He was managed with antihypertensive, including angiotensin-converting enzyme inhibitors, steroids and immunosuppressants, and Omega-3 fatty acids. There was remission of the symptoms and the patient's serum creatinine and sonogram findings returned to baseline. Routine follow-up along with the appropriate use of medications can limit disease complications and progression.

Serum cystatin C and inflammatory factors related to COVID-19 consequences

BackgroundBesides impaired respiratory function and immune system, COVID-19 can affect renal function from elevated blood urea nitrogen (BUN) or serum creatinine (sCr) levels to acute kidney injury (AKI) and renal failure. This study aims to investigate the relationship between Cystatin C and other inflammatory factors with the consequences of COVID-19.MethodsA total of 125 patients with confirmed Covid-19 pneumonia were recruited in this cross-sectional study from March 2021 to May 2022 at Firoozgar educational hospital in Tehran, Iran. Lymphopenia was an absolute lymphocyte count of less than 1.5 × 109/L. AKI was identified as elevated serum Cr concentration or reduced urine output. Pulmonary consequences were evaluated. Mortality was recorded in the hospital one and three months after discharge. The effect of baseline biochemical and inflammatory factors on odds of death was examined. SPSS, version 26, was used for all analyses. P-vale less than 0.05 was considered significant.ResultsThe highest amount of co-morbidities was attributed to COPD (31%; n = 39), dyslipidemia and hypertension (27%; n = 34 for each) and diabetes (25%; n = 31). The mean baseline cystatin C level was 1.42 ± 0.93 mg/L, baseline creatinine was 1.38 ± 0.86 mg/L, and baseline NLR was 6.17 ± 4.50. Baseline cystatin C level had a direct and highly significant linear relationship with baseline creatinine level of patients (P < 0.001; r: 0.926). ). The average score of the severity of lung involvement was 31.42 ± 10.80. There is a direct and highly significant linear relationship between baseline cystatin C level and lung involvement severity score (r = 0.890, P < 0.001). Cystatin C has a higher diagnostic power in predicting the severity of lung involvement (B = 3.88 ± 1.74, p = 0.026). The mean baseline cystatin C level in patients with AKI was 2.41 ± 1.43 mg/L and significantly higher than patients without AKI (P > 0.001). 34.4% (n = 43) of patients expired in the hospital, and the mean baseline cystatin C level of this group of patients was 1.58 ± 0.90 mg/L which was significantly higher than other patients (1.35 ± 0.94 mg/L, P = 0.002).Conclusioncystatin C and other inflammatory factors such as ferritin, LDH and CRP can help the physician predict the consequences of COVID-19. Timely diagnosis of these factors can help reduce the complications of COVID-19 and better treat this disease. More studies on the consequences of COVID-19 and knowing the related factors will help treat the disease as well as possible.

Efficacy and safety of entecavir for hepatitis B virus-associated glomerulonephritis with renal insufficiency.

HBV-GN is one of the most common secondary kidney diseases in China. Entecavir is a first-line antiviral therapy in patients with HBV-GN. This retrospective study explored whether entecavir is effective and safe for the treatment of HBV-GN with renal insufficiency. We screened patients diagnosed with HBV-GN in The Affiliated Hospital of Qingdao University who had elevated serum creatinine levels. Group 1 (30 patients) was given entecavir as antiviral treatment. Group 2 (28 patients) was treated with ARBs. Changes in renal function and the possible influencing factors were observed, with a mean follow-up duration of 36months. At the end of follow-up, the elevation in the serum creatinine level and reduction in the eGFR were greater in group 1 than in group 2. The overall renal survival rate, using eGFR < 15ml/min as the primary renal end point, was 96.7% in group 1 and 67.9% in group 2. Urine protein excretion was decreased in both groups. Treatment with entecavir and the remission of proteinuria were protective factors against renal function impairment, while a lower baseline eGFR was a risk factor for progression to ESRD. Entecavir slows the progression of renal function impairment in HBV-GN and exerts a significant renal protective effect.

Effectiveness of analog of Humanin in ameliorating streptozotocin-induced diabetic nephropathy in Sprague Dawley rats

Diabetes mellitus (DM) is associated with numerous complications, including nephropathy, which principally occur due to hyperglycemia-induced oxidative stress and inflammation. Humanin (HN), a novel peptide generated from mitochondria, has anti-oxidant and anti-inflammatory potential as observed in different disease models. However, role of HN in diabetic nephropathy (DN) has not yet been explored. This study aimed to evaluate biochemical and molecular aspects of the effects of HN analog, Humanin-glycine ([S14G]-humanin) on streptozotocin (STZ)-induced rat model of DN. Ninety Sprague Dawley (SD) rats were randomly segregated into three groups – A (control), B (disease control) and C (treatment). DM type-I was induced in group B and C via single intra-peritoneal dose of STZ (45 mg/Kg). Seven days following STZ injection, rats were deemed diabetic if their blood glucose level was > 250 mg/dL. Subsequently, diabetic rats in group C were injected with [S14G]-humanin intra-peritoneally (0.4 mg/Kg/day) for sixteen weeks. Biochemical analysis revealed that diabetic rats had markedly elevated levels of serum glucose, creatinine, BUN, TNF-α, and kidney tissue SOD. Whereas, significant decline was detected in serum insulin and albumin levels. All these parameters were significantly reversed in group C after administering [S14G]-humanin. Moreover, qRT-PCR analysis displayed up-regulation of pro-inflammatory (IL-18, IL-6, IL-1α, IL-1β, TNF-α) and down-regulation of anti-inflammatory cytokines (IL-10, IL-1RN, IL-4) in diabetic rats (group B). [S14G]-humanin treatment significantly reversed the expression of IL-18 and IL-1α, however, change in relative expression of IL-6, IL-1β, TNF-α and anti-inflammatory cytokines was insignificant (group C). Conclusively, the findings of this study depicted potential therapeutic role of [S14G]-humanin in pre-clinical rodent model of DN.

The influence of vancomycin on renal functions, the predictors and associated factors for nephrotoxicity.

Vancomycin has been widely used in the last six decades to treat methicillin-resistant S. aureus (MRSA) and other resistant gram-positive infections. The risk of vancomycin toxicity increases with the utilization of higher doses while treating the resistant form of bacterial infections. Nephrotoxicity is one of the major complications reported to be a hinderance in the prognosis of vancomycin therapy. This hospital-based study aimed to highlight the influence of vancomycin on renal function with special emphasis on identifying the predictors and augmenting factors for nephrotoxicity. A cross-sectional, unicentric, hospital-based study was conducted at King Fahad Specialist Hospital (KFSH) in Qassim region in Saudi Arabia (KSA). It included 319 hospitalized patients who received vancomycin at intermittent doses (15 to 30 mg/kg IV per day) based on the diseased state. Data regarding vancomycin dose, frequency, duration and data of renal function tests and type of admission were analysed to evaluate their influence on the renal function using parameters such as blood urea, serum creatinine levels and creatinine clearance. One-way ANOVA and Spearman correlation test were used in the analysis of data. Both male and female patients treated with vancomycin had significantly (p<0.05) elevated blood urea and serum creatinine levels compared to baseline levels while creatinine clearance was non-significantly varied. Increasing age, increasing body weight, higher vancomycin dose and trough levels, increased vancomycin frequency and duration, critically ill patients and site of infection were factors associated with significant (p<0.05) increases in blood urea and serum creatinine levels with reduction in creatinine clearance. Data suggested that vancomycin treatment reduced the renal function in patients and indicated its association with several predictors and confounding factors. The findings of the study might assist in identifying the patients under risk from the vancomycin-induced nephrotoxicity and in designing the preventive strategies to reduce such complications.

Ghrelin Ameliorates Nicotine induced Renal Damage in Balb/c mice: RCT

Background: Kidneys are the major organs responsible for elimination of toxic metabolites from the body. Aim: To determine role of ghrelin in mitigating nicotine induced renal damage in Balb/c mice by assessing serum creatinine levels, renal tissue MDA levels and renal tubular histological changes. Methodology: It was a Randomized Control Trial. Healthy male BALB/c mice (n=27) through non probability convenience sampling were taken from NIH Islamabad and sorted into 3 groups (nine each). Group I was labeled as control group and given intraperitoneal normal saline for 29 days. Group II was labeled as nicotine group and received intraperitoneal nicotine for 29 days. Group III was labeled as ghrelin + nicotine and received intraperitoneal ghrelin on alternate days and nicotine daily for 29 days. On 30th day intracardiac sampling was done for estimation of serum creatinine. After intra cardiac sampling dissection was done to obtain renal tissue sample for lipid peroxidation and histological analysis. Data was evaluated by using SPSS version 23. One way ANOVA and post hoc tukey’s test were applied. Results: In group 2, nicotine administration markedly elevated serum creatinine and tissue MDA levels whereas ghrelin administration along with nicotine in group 3 restored serum creatinine and tissue MDA levels back to normal. Renal tubular changes caused by nicotine in group-2 are also mitigated by ghrelin and nicotine administration in group-3. Practical Implication: Ghrelin a newly discovered peptide has shown to have anti-oxidant properties and nephro-protective effect thus has potential to reduce renal damage. It can restored creatinine levels thus minimizes renal damage. Conclusion: It was concluded that ghrelin protects kidneys against nicotine induced renal damage by restoring serum creatinine, lipid peroxidation marker and histological changes. Keywords: Ghrelin, Lipid Peroxidation, Nicotine, Nephro-Protection, Anti-Oxidant and MDA.

Burden and severity of deranged electrolytes and kidney function in children seen in a tertiary hospital in Kano, northern Nigeria.

Derangement in serum electrolytes and kidney function is often overlooked, especially in resource-constrained settings, and associated with increased risk of morbidity and mortality. This study aimed to describe the burden of derangements in serum electrolytes and kidney function in children presenting to a tertiary hospital in Nigeria. The laboratory records of all children who had serum electrolytes urea and creatinine ordered on their first presentation to hospital between January 1 and June 30, 2017 were retrospectively reviewed. Basic demographic data including admission status (inpatient or outpatient) were recordedandserum levels of sodium, potassium, chloride and bicarbonate were assessed for derangements usingnormal values from established reference ranges. Results of repeat samples were excluded. Kidney function was classified based on the serum creatinine relative to normal values for age and sex. During the study period, 1909 children (60.3% male); median (IQR) age 42 (11.9) months had serum chemistry and 1248 (65.4%) were admitted. Results of their first samples were analyzed. Electrolyte derangements were present in 78.6% of the samples most commonly hyponatraemia (41.1%), low bicarbonate(37.2%), hypochloraemia (33.5%) and hypokalemia(18.9%). Azotaemia was found in 20.1% of the results. Elevated serum creatinine levels were found in 399 children (24.7%), 24.1% of those being in the severe category. Children aged 5 years and younger accounted for 76.4% of those with derangement in kidney function. One hundred and eight outpatients (17.8%) had deranged kidney function. Deranged serum electrolytes and kidney function were common in this cohort.

Clinical features of children with coronavirus disease 2019 caused by Delta variant infection in different age groups

To study the clinical features of children with coronavirus disease 2019 (COVID-19) caused by Delta variant infection in different ages groups. A total of 45 children with COVID-19 caused by Delta variant infection who were hospitalized in the designated hospital in Henan Province, China, from November 17 to December 17, 2021, were included. They were divided into three groups: <6 years group (n=16), 6-13 years group (n=16), and >13 years group (n=13). The three groups were compared in clinical features and laboratory examination data. COVID-19 in all age groups was mainly mild. Main manifestations included cough and expectoration in the three groups, and fever was only observed in the 6-13 years group. The <6 years group had significantly higher serum levels of aspartate aminotransferase, lactate dehydrogenase, and creatine kinase isoenzymes than the other two groups (P<0.05). The 6-13 years group had the highest proportion of children with elevated serum creatinine levels (50%). Among the three groups, only 4 children in the >13 years group had an increase in serum C-reactive protein levels. The 6-13 years group had the lowest counts of CD3+CD4+ lymphocytes, CD3+CD8+ lymphocytes, and natural killer cells in the peripheral blood among the three groups. The >13 years group had a significantly higher positive rate of SARS-CoV-2 IgG on admission than the other two groups (P<0.05). There was no significant difference in the imaging findings on chest CT among the three groups (P>0.05). The clinical features of COVID-19 caused by Delta variant infection in children of different age groups may be different: children aged <6 years tend to develop myocardial injury, and those aged 6-13 years have fever except cough and expectoration and tend to develop renal and immune dysfunction.

End-Stage Renal Disease, Autoimmune Hepatitis, Alveolar Hemorrhage and ANCA Vasculitis as a Complication of Chronic Hepatitis B Virus: An Unusual Case Report

Background: End stage renal disease, autoimmune hepatitis and alveolar hemorrhage have rarely been reported as the complications of hepatitis B virus infection that can potentially be triggered by an antibody-mediated vasculitis as a result of a viral infection. The following was a case report detailing a patient presenting with all three of the above presentations who was cytoplasmic antineutrophil cytoplasmic antibody-positive and a chronic carrier of hepatitis B virus. Case presentation: A 52-year-old Malagasy woman presented in our intensive care unit for acute respiratory failure with end-stage renal disease and deterioration in general condition. She was managed with steroids, non-invasive ventilation, and hemodialysis. Laboratory test showed elevated levels of serum creatinine and liver enzymes. An extensive workup was done to find the etiology of elevated liver enzymes. Only blood work that came back positive was for chronic inactive hepatitis virus B and positive autoantibody suggestive of autoimmune hepatitis. A computed tomography scan of her lung revealed features suggestive of bilateral alveolar hemorrhage. Workup for other causes of vasculitis, including anti-neutrophil cytoplasmic antibodies (ANCA) was positive for c-ANCA antibody to proteinase 3. Medical investigations allowed excluding other infectious diseases, malignancies and other rheumatic and vasculitis affections. Administration of lamivudine® orally was done. The patient was followed for more than one year and there were no other new systematic symptoms. Conclusion: This case report showed the possibility of hepatitis B virus-induced vasculitis as the cause of alveolar hemorrhage, autoimmune hepatitis, and end stage renal disease. The origin of these symptoms was attributed to immune complex-mediated vasculitis induced by antineutrophil cytoplasmic antibody.

THE INHIBITION EFFECT OF MORINGA (Moringa oleifera L.) LEAVES AND RED GINGER RHIZOME (Zingiber officinale Rosc.) PT. "P" ETHANOL EXTRACT ON ENHANCEMENT SERUM CREATININE LEVELS OF MALE WISTAR RATS DYSLIPIDEMIA MODEL

The elevation of serum creatinine levels can be used as a biomarker of decreased kidney function. Dyslipidaemia is one of the causes of decreased kidney function. Long-term consuming statins has been shown to lower cholesterol levels but can increase serum creatinine levels. Moringa leaves (Moringa oleifera L.) and red ginger rhizomes (Zingiber officinale Rosc.) have antioxidant effects. The aim of this study was to determine the inhibitory effect on increasing serum creatinine levels of the concoction Moringa Leaves and Red Ginger Rhizome extract (CML-RGRE). This True Laboratory Experimental Study with Completely Randomized Design was conducted on 30 male Wistar rat dyslipidemia models, induced by high-fat feeding (HFF) and Propylthiouracil (PTU) 0.01% for 21 days. The subjects were divided into 6 groups (n=5), during treatment all subjects were still given HFD and PTU. Groups I, II, III were treated with CML-RGRE dose 135, 202.5, 270 mg/kg BW, IV as dyslipidemia control no added any treatment, comparison control groups V treated with 1.8 mg/kg BW and VI with fenofibrate 5.4 mg/kg BW. Serum creatinine levels (mg/dL) of all subjects were measured after 7 days acclimatization, after creating dyslipidemia models, and after 21 days treatment by using a spectrophotometer with colorimetric kinetic methods. Data of decreased serum creatinine levels were analyzed using ANOVA test, followed by Fischer's LSD, ? = 0.05. All doses of CML-RGRE were very effectively inhibited the increase of serum creatinine levels (p &lt; 0.01). The concoction Moringa leaves, and Red Ginger Rhizome ethanol extract has effectively inhibited the increase of serum creatinine levels of animal dyslipidemia models.

Electrolyte Imbalance Among Bangladeshi Patients With COVID-19.

Introduction Infection with SARS-CoV-2 begins in the lower respiratory tract, but COVID-19 often involves the renal system, resulting in serum electrolyte imbalance. Monitoring serum electrolyte levels and parameters of liver and kidney function is essential to understand disease prognosis. Objectives This study aimed to determine the effect of imbalances in serum electrolytes and other parameters on COVID-19 severity. Material and method This retrospective study comprised 241 patients, ages 14 years and older, including 186 patients who were moderately affected and 55 who were categorized as severely affected by COVID-19. Serum electrolytes (sodium (Na+), potassium (K+), and chloride (Cl-)) and biomarkers of kidney and liver function (creatinine and alanine aminotransferase (ALT)) were measured and correlated with disease severity. This research was conducted among admitted patients of Holy Family Red Crescent Medical College Hospital designated into two groups based on retrospective hospital records. Individuals with moderate illness had evidence of lower respiratory tract infection (cough, cold, breathless, etc.) during clinical assessment or imaging (chest X-ray and computed tomography (CT) scan of the lungs) and have an oxygen saturation by pulse oximetry (SpO2) ≥ 94% on room air at sea level. The severely ill group involved individuals with SpO2 ≤94% on room air at sea level and respiratory rate ≥ 30 breaths/minute, and critically ill patients are those who needed mechanical ventilation or required intensive care unit (ICU) care. This categorization was based on the Coronavirus Disease 2019 (COVID-19) Treatment Guidelines (https://www.covid19treatmentguidelines.nih.gov/about-the-guidelines/whats-new/). Results Average Na+and creatinine increased by 2.30 parts (95% confidence interval (CI) = 0.20, 4.81, P = 0.041) and 0.35 units (95% CI = 0.03, 0.68, P = 0.043) in severe cases compared with moderate cases. Older participants had relatively Na+lowered to -0.06 parts (95% CI = -0.12, -0.001, P = 0.045), significant Cl- reduction by 0.09 units (95% CI = -0.14, -0.04, P = 0.001), and ALT by 0.47 units (95% CI = -0.88, -0.06, P = 0.024), whereas serum creatinine was increased by 0.01 parts (95% CI = 0.001, 0.02, P = 0.024). The creatinine and ALT of COVID-19 participants were significantly higher in males by 0.34 units and 23.2 units, respectively,compared with females. In severe COVID-19 cases compared with moderate cases, the risks of hypernatremia, elevated chloride levels, and elevated serum creatinine levels were increased by 2.83-fold (95% CI = 1.26, 6.36, P = 0.012), 5.37-fold (95% CI = 1.90, 15.3, P = 0.002), and 2.00-fold (95% CI = 1.08, 4.31, P = 0.039), respectively. Conclusion Serum electrolyte and biomarker levels can serve as good indicators of the condition and disease prognosis of patients with COVID-19. Our purpose in this study was to determine the association between serum electrolyte imbalance and disease severity. We collected data from ex post facto hospital records and did not intend to assess the mortality rate. Consequently, this study expects that the prompt diagnosis of electrolyte disparity or disturbance possibly minimizes COVID-19-related morbidity and mortality.

Plasma Trimethylamine N-Oxide Levels Are Associated with Poor Kidney Function in People with Type 2 Diabetes

Previous studies have linked elevated plasma trimethylamine N-oxide (TMAO) levels to poor renal function. The relationship between TMAO and chronic kidney disease (CKD) in type 2 diabetes (T2D) is still unclear. We investigated the association between plasma TMAO levels and CKD in patients with T2D. A cross-sectional study of 133 patients with T2D with or without CKD has been conducted. Blood biomarkers of kidney function, diabetes, and inflammation were assessed in the study participants. Plasma TMAO levels were quantified using UPLC-MS/MS. People with T2D and CKD exhibited significantly higher plasma TMAO levels [10.16 (5.86-17.45) µmol/L] than those without CKD [4.69 (2.62-7.76) µmol/L] (p = 0.002). Participants in the highest quartile of TMAO levels (>8.38 µmol/L) presented relatively elevated serum creatinine levels and a higher number of people with CKD than those in the lower quartiles. TMAO levels were significantly correlated with kidney function biomarkers, including estimated glomerular filtration rate and urinary albumin to creatinine ratio. The association between TMAO and CKD was evident (p < 0.0001) and remained significant after adjusting for risk factors of kidney disease, including age, gender, body mass index, duration of diabetes, and smoking. These findings suggest the association between plasma TMAO and CKD in patients with T2D.

Preventive Effects of Pimpinella anisum L. and Dracocephalum moldavica L. Hydroalcoholic Extract Against Acute Contrast-induced Nephropathy

Background: Contrast-induced nephropathy (CIN) is nephrotoxicity due to contrast media characterized by elevated serum creatinine levels. The formation of oxygen free radicals is one of the causes of CIN. Objective: Given the antioxidant properties of Pimpinella anisum L and Dracocephalum moldavica L, this study aimed to investigate the effects of their hydroalcoholic extracts on kidney tissue histopathology and CIN biochemical factors. Methods: In this experimental study, 40 male Wistar rats were randomly divided into four groups: 1) control, 2) contrast agent, 3) P. anisum+contrast agent, and 4) D. moldavica+contrast agent. After the tests, kidney tissue histopathological damages and related biochemical factors were evaluated. Results: Kidney tissue damage, levels of aspartate aminotransferase (GOT/AST), alanine aminotransferase (GPT/ALT) and blood urea nitrogen, serum creatinine (P&lt;0.001), and malondialdehyde (P&lt;0.01) of kidney tissue were lower in both extract-treated groups than in contrast agent group, but the decrease in serum MDA was significant only in the group given P. anisum extract (P&lt;0.01). Serum antioxidant capacity was higher in P. anisum+contrast agent group than in the contrast agent group (P&lt;0.01). Kidney tissue antioxidant capacity was significantly higher in the groups given P. anisum and D. moldavica than in the contrast agent group (P&lt;0.01 and P&lt;0.001, respectively). In addition, hydroalcoholic extracts of P. anisum and D. moldavica resulted in a decrease in CIN. Conclusion: Given the decrease in CIN by P. anisum and D. moldavica extracts in rats, it seems that these plants are beneficial for people at risk who need to use contrast agents.

Persistent hypertension at 3 months postpartum among women with hypertensive disorders of pregnancy at a tertiary hospital in Southwestern Uganda

Hypertension is a key contributor to the global epidemic of cardiovascular disease and is responsible for more deaths worldwide than any other cardiovascular risk factor. Hypertensive disorders of pregnancy, of which preeclampsia and eclampsia are the most common forms, have been shown to be a female-specific risk factor for chronic hypertension. This study aimed to determine the proportion and risk factors for persistent hypertension at 3 months after delivery among women with hypertensive disorders of pregnancy in Southwestern Uganda. This was a prospective cohort study of pregnant women with hypertensive disorders of pregnancy admitted for delivery at Mbarara Regional Referral Hospital in Southwestern Uganda from January 2019 to December 2019; however, women with chronic hypertension were excluded from the study. The participants were followed up for 3 months after delivery. Participants with a systolic blood pressure of ≥140 mm Hg or a diastolic blood pressure of ≥90 mm Hg or receiving antihypertension therapy at 3 months after delivery were considered to have persistent hypertension. Multivariable logistic regression was used to determine independent risk factors associated with persistent hypertension. A total of 111 participants with hypertensive disorders of pregnancy diagnosed at hospital admission were enrolled with a follow-up rate of 49% (54/111) at 3 months after delivery. Of these women, 21 of 54 (39%) had persistent hypertension 3 months after delivery. In the adjusted analyses, an elevated serum creatinine level (>106.08 µmol/L [≤1.2 mg/dL]) at admission for delivery was the only independent risk factor for persistent hypertension at 3 months after delivery (adjusted relative risk, 1.93; 95% confidence interval, 1.08-3.46; P=.03), controlling for age, gravidity, and eclampsia. Approximately 4 of 10 women presenting with hypertensive disorders of pregnancy at our institution remained hypertensive 3 months after delivery. Innovative strategies are needed to identify these women and provide long-term care to optimize blood pressure control and reduce future cardiovascular disease after hypertensive disorders of pregnancy.

Kidney involvement of chronic active Epstein-Barr virus infection.

A 54-year-old Japanese woman presented with a fever of unknown origin and renal dysfunction. She had experienced intermittent fever for 10 years, but the frequency increased to a constant fever. Her renal function had gradually deteriorated over the past year, and serum creatinine and urinary α1-microglobulin levels were elevated to 2.23 mg/dL and 113 mg/L, respectively. Physical and laboratory examinations were unremarkable, except for mild anemia and elevated serum creatinine levels. Analysis of peripheral blood lymphocyte subsets showed 59% CD3, 35% CD4 and 31% CD8. Epstein-Barr virus (EBV) serology showed elevated levels of EBV capsid antigen IgG and EBV nuclear antigen (1:1280 and 1:40, respectively). Plasma EBV-DNA level was 5.63 log IU/mL, and an oligoclonal band was detected by Southern blot hybridization of EBV terminal repeat analysis. Quantification of EBV-DNA in peripheral lymphocyte subset using magnetic beads showed that EBV predominantly resided in CD4+ T-cells. (CD4, 258,768; CD8, 27,738; and CD56, 23,369; IU/µgDNA, respectively). T-cell receptor α gene rearrangement was undetected. Based on the above, she was diagnosed with chronic active EBV infection (CAEBV). 18F-fluorodeoxyglucose positron emission tomography/computerized tomography showed bilateral kidney enlargement and mildly enhanced uptake (maximum standardized uptake value 4.08 g/mL) (Figure 1 top left). Kidney biopsy specimen stained with hematoxylin and eosin showed diffuse tubulointerstitial infiltration of small to medium-sized lymphocytes in the renal parenchyma (Figure 1 top right). Massive infiltration of CD4+ T-cells was documented by immunohistochemical staining (Figure 1 bottom left). Furthermore, EBV-infected cells were detected by in situ hybridization with EBV-encoded RNA (EBER) (Figure 1 bottom right). Immunostaining of EBV nuclear antigen-2 and latent membrane protein 1 were negative. EBER-positive cells were distributed in the same region as CD4+ T-cells, consistent with the predominant presence of EBV-DNA in CD4+ T-cells. Her renal function had improved after initiating chemotherapy, and she is scheduled for hematopoietic stem cell transplantation. The clinical features of EBV infection vary according to the type of EBV-infected cells. The predominant EBV-infected cells in EBV-induced hemophagocytic lymphohistiocytosis are CD8+ T cells, whereas in CAEBV, CD4+ T cells are predominantly infected. Although rare, renal invasion of EBV should be considered in cases with renal impairment, and its clinical significance needs to be investigated. AF and SS wrote and edited the manuscript, provided patient care and reviewed the literature. KS and MT provided patient care. TS and KM wrote and edited the manuscript. All authors reviewed and approved the final version of the manuscript We thank Dr. Yuka Torii (Department of Pediatrics, Nagoya University, Japan) for quantification of the EBV viral load of lymphocyte subsets using magnetic beads. We also thank Dr. Hiroshi Kimura (Department of Virology, Nagoya University, Japan) for his helpful advice on patient care. We appreciate the staff of the Department of Hematology, Kameda Medical Center for providing patient care. We thank Editage (www.editage.jp) for English language editing. The authors declare they have no conflicts of interest. The authors received no specific funding for this work. This study was conducted according to the Declaration of Helsinki, and written consent was obtained from the patient for this report. The patient provided written informed consent for the publication of this case, with the removal of all identifying information to ensure anonymity and maintain privacy. The data that support the findings of this study are available from the corresponding author upon reasonable request. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Pharmaceutical Development of Intraperitoneal Arachis hypogaea as a Renal Protective Agent.

Kidneys are among the vital organs of the human body; therefore, damage from any exogenous/endogenous agent may put human life at risk. Arachis hypogaea (AH) contains different free radical scavenging flavonoids, stilbenes, and tannins. This research aimed to elucidate the possible nephroprotective mechanism of AH methanolic crude extract (AHcr) and n-hexane oil fraction (AHO) against gentamycin-induced nephrotoxicity. After the extraction of the crude oil of the plant, they were tested against a Gentamycin (GM)-treated group of Swiss Albino mice for their nephroprotective action. Animals were divided into six (6) equal groups with five (5) animals in each group. These groups were: control group (0.5 mL normal saline via intraperitoneal -i.p), gentamycin group (gentamycin 100 mg/kg i.p), Silymarin + gentamycin group (Silymarin 50 mg/kg and gentamycin 100 mg/kg i.p), plant extract (AHcr1) and gentamycin group (AHcr1 250 mg/kg and gentamycin 100 mg/kg i.p), AHcr2 + gentamycin group (AHcr2; 500 mg/kg and gentamycin 100 mg/kg i.p) and the hexane oil fraction (AHO) + gentamycin (AHO 1 mL/kg and GM 100 mg/kg i.p). After completion of doses, animals were sacrificed for the collection of blood to further investigate biochemical changes and histopathological changes in kidney tissues. Serum creatinine, urea, and blood urea nitrogen significantly increased (p < 0.001) in the gentamycin-treated group as compared to the control group. The elevated level of serum creatinine, urea, and blood urea nitrogen was decreased significantly (p < 0.001) in groups treated with AHcr and AHO compared to the gentamycin group. Similarly, the histopathological study of kidney tissues from the gentamycin group showed tubular necrosis, vacuolation, and fibrosis. The effect of crude extract and hexane soluble fraction of AH caused a significant reversal of gentamycin-induced nephrotoxicity.