Higher Serum Urea Research Articles

Establishment and validation of a clinical risk scoring model to predict fatal risk in SFTS hospitalized patients

BackgroundSevere fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne infection with a high case fatality rate. Significant gaps remain in studies analyzing the clinical characteristics of fatal cases.MethodsFrom January 2017 to June 2023, 427 SFTS cases were included in this study. A total of 67 variables about their demographic, clinical, and laboratory data were collected. Univariate logistic regression and the least absolute shrinkage and selection operator (LASSO) method was used to screen predictors from the cohort. Multivariate logistic regression was used to identify independent predictors and nomograms were developed. Calibration, decision curves and area under the curve (AUC) were used to assess model performance.ResultsThe multivariate logistic regression analysis screened out the four most significant factors, including age > 70 years (p = 0.001, OR = 2.516, 95% CI 1.452–4.360), elevated serum PT (p < 0.001, OR = 1.383, 95% CI 1.143–1.673), high viral load (p < 0. 001, OR = 1.496, 95% CI 1.290–1.735) and high level of serum urea (> 8.0 μmol/L) (p < 0.001, OR = 4.433, 95% CI 1.888–10.409). The AUC of the nomogram based on these four factors was 0.813 (95% CI, 0.758–0.868). The bootstrap resampling internal validation model performed well, and decision curve analysis indicated a high net benefit.ConclusionsThe nomogram based on age, elevated PT, high serum urea level, and high viral load can be used to help early identification of SFTS patients at risk of fatality.

Abdominal Hypoperfusion and Acute Kidney Injury in the Critically Ill Patient with Liver Cirrhosis: A Prospective Cohort Study

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Reduced abdominal perfusion pressure (APP) is an underdiagnosed potential pathophysiological mechanism for acute kidney injury (AKI) in the patient with liver cirrhosis and ascites. This study aimed to analyze the prevalence of abdominal hypoperfusion (AhP) (APP &amp;lt;60 mm Hg) and the impact of APP on AKI in critically ill patients with liver cirrhosis. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; This was a post hoc analysis from a prospective cohort study set in a general ICU at a tertiary university hospital. Patients were recruited between October 2016 and December 2021. Acute renal failure (ARF) was defined by stage 3 AKI according to the International Club of Ascites. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Fifty-eight patients where included, with a mean age of 57 (±8.4) years, 79% were male, and 93% had acute-on-chronic liver failure at admission. The prevalence of AhP reached 75%, and 29% of cases had persisting AhP during the first week of ICU stay. Patients with baseline AhP had a higher 28-day mortality compared to those without AhP (respectively, 76% vs. 49%, &lt;i&gt;p&lt;/i&gt; = 0.03). Acute renal failure developed in 48% of patients. Higher serum urea (aOR: 1.01, 95% CI: 1.00–1.02, &lt;i&gt;p&lt;/i&gt; = 0.04) and white blood cell count (aOR: 1.1, 95% CI: 1.01–1.2, &lt;i&gt;p&lt;/i&gt; = 0.02) at ICU admission, as well as low persisting APP (aOR: 0.9, 95% CI: 0.86–0.98, &lt;i&gt;p&lt;/i&gt; = 0.02) were independent risk factors for ARF. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Critically ill patients with liver cirrhosis presented a high prevalence of ARF, independently associated with higher baseline serum urea and WBC, and lower persisting APP. A structured clinical approach to optimize APP may reduce renal dysfunction in high-risk patients with cirrhosis.

Additional Benefits of Serum Oncostatin M Levels Compared to Cardiac Troponin in Non-ST Elevation Myocardial Infarction.

The use of high-sensitivity troponin levels increases the sensitivity of the diagnosis of non-ST elevation myocardial infarction (NSTEMI). However, the inclusion of other factors in the differential diagnosis, apart from atherothrombosis causing myocardial injury, decreases the specificity of high-sensitivity troponin. In this study, we compared the efficacy of high-sensitivity troponin with serum oncostatin M in NSTEMI cases with elevated urea and creatinine. This study was performed with a prospective cross-sectional sample. Ninety participants with coronary angiography performed due to a preliminary diagnosis of NSTEMI were included. High-sensitivity troponin I, creatine kinase-MB, lactate dehydrogenase, serum transaminase and oncostatin M levels were quantitatively measured for the first 4-8 hours from the onset of symptoms. All participants had coronary angiography performed within the first 12 hours after attending the emergency service. Based on coronary angiography data, patients with significant coronary stenosis or occlusion detected during coronary angiography were defined as group A, and patients with no occlusion in the coronary artery and who did not require an additional interventional procedure were defined as group B. The SYNTAX 2 score was used to determine the severity of coronary artery disease. Patients in both groups A and B had similar age, sex distribution and comorbidities. Group A had higher serum urea, creatinine, oncostatin M and high-sensitivity troponin I values than group B. With 585 pg/ml as the cut-off value, serum oncostatin M had a sensitivity of 88.6% and specificity of 85% for the diagnosis of NSTEMI. Logistic regression multivariate analysis showed that serum oncostatin M and high-sensitivity troponin I values had diagnostic efficacy for NSTEMI. Serum oncostatin M was found to be more effective than high-sensitivity troponin I in patients with elevated urea and creatinine. Serum oncostatin M had similar sensitivity and specificity for NSTEMI diagnosis as high-sensitivity troponin I. Serum OSM can especially be considered as a complementary diagnostic biomarker for NSTEMI in patients with renal dysfunction.

Assessment of Serum Urea and Creatinine Levels in Diabetic Patients

Diabetic nephropathy is the leading cause of renal morbidity which occurs when chronic diabetes destroys the filtering system of the kidneys. Serum urea and creatinine are widely used as renal function test parameters. This study aims to assess the level of serum urea and creatinine in diabetic patients and their relationship with each other. The study was conducted in Ayub Teaching Hospital from September 15 to December 20, 2019. A total of 176 samples from confirmed diabetic patients were analyzed including 85 female and 91 male patients. Also, 83 control samples were taken for this study. Serum urea and creatinine levels were assessed to evaluate diabetic nephropathy in diabetic patients. SPSS (version 23) was used for statistical analysis. Pearson correlation analysis was used to check the relationship of blood sugar level, creatinine, and urea. Descriptive statistics (mean ± SD) were measured for the continuous variable. Scatter plot diagrams were added for the easy visualization and interpretation of the data. The significant level was set at p &lt; 0.05. Out of the 176 diabetic samples, 32 had abnormally high serum creatinine and 66 had abnormal serum urea. In controls, one individual had high creatinine and three individuals had high serum urea. A significant increase in both urea and creatinine levels was observed in diabetic samples. Both serum urea and creatinine showed a strong positive correlation with the level of glucose and remained statistically significant (p &lt; 0.01). Similarly, blood glucose level showed a strong correlation with the renal function test parameters. Hence, it was concluded that serum urea and creatinine are important parameters to assess kidney function in diabetes mellitus.&#x0D;

The effect of dehydration, hyperchloremia and volume of fluid resuscitation on acute kidney injury in children admitted to hospital with diabetic ketoacidosis.

Acute kidney injury (AKI) is a recognized comorbidity in pediatric diabetic ketoacidosis (DKA), although the exact etiology is unclear. The unique physiology of DKA makes dehydration assessments challenging, and these patients potentially receive excessive amounts of intravenous fluids (IVF). We hypothesized that dehydration is over-estimated in pediatric DKA, leading to over-administration of IVF and hyperchloremia that worsens AKI. Retrospective cohort of all DKA inpatients at a tertiary pediatric hospital from 2014 to 2019. A total of 145 children were included; reasons for exclusion were pre-existing kidney disease or incomplete medical records. AKI was determined by change in creatinine during admission, and comparison to a calculated baseline value. Linear regression multivariable analysis was used to identify factors associated with AKI. True dehydration was calculated from patients' change in weight, as previously validated. Fluid over-resuscitation was defined as total fluids given above the true dehydration. A total of 19% of patients met KDIGO serum creatinine criteria for AKI on admission. Only 2% had AKI on hospital discharge. True dehydration and high serumurea levels were associated with high serumcreatinine levels on admission (p = 0.042; p < 0.001, respectively). Fluid over-resuscitation and hyperchloremia were associated with delayed kidney recovery (p < 0.001). Severity of initial AKI was associated with cerebral edema (p = 0.018). Dehydration was associated with initial AKI in children with DKA. Persistent AKI and delay to recovery was associated with hyperchloremia and over-resuscitation with IVF, potentially modifiable clinical variables for earlier AKI recovery and reduction in long-term morbidity. This highlights the need to re-address fluid protocols in pediatric DKA.

Analysis of Kidney Function Tests as Predictor of Mortality in COVID-19

Cytokine release syndrome and Acute Respiratory Distress Syndrome (ARDS) increase the incidence of Acute Kidney Injury (AKI) in COVID-19 patients, which is associated with a poor prognosis and risk of death. The purpose of this study was to analyze urea, creatinine, and eGFR values as predictors of mortality in COVID-19 patients. A retrospective cohort study was carried out using secondary data from medical records of 311 COVID-19 patients who were treated at the Hasanuddin University State Higher Education Hospital from August 2020 to August 2021. Data were analyzed using the Mann-Whitney test, Chi-Square, and Logistic Regression. The risk of mortality for COVID-19 patients with urea levels &gt; 53 mg/dL was 5.128 times higher than that of urea levels ‰ 53 mg/dL (OR=5.128; CI =2.530 – 10.391, p&lt;0.001). The risk of mortality for COVID-19 patients with creatinine levels &gt; 1.3 mg/dL was 2.696 times higher than that of creatinine levels ‰ 1.3 mg/dL (OR= 2.696; CI = 1.330 – 5.463, p&lt;0.001). The risk of mortality in COVID-19 patients with an eGFR &lt; 90 mL/min/1.73 m2 was 3.692 times higher than that of an eGFR ‰ 90 mL/min/1.73 m2 (OR=3.692; CI = 2.134 – 6.389, p&lt;0.001). Multiple logistic regression analysis showed that urea and eGFR were better predictors of mortality than creatinine (OR= 0.374, p=0.002 vs. OR 0.344, p=0.007 vs. OR 1.192, p=0.694). The COVID-19 patient group with high serum urea and creatinine levels and low eGFR values had a greater risk of mortality compared to the group of patients who had normal results. Urea levels and eGFR values were better predictors of mortality than serum creatinine.

Clinical characteristics and outcomes of critically ill coronavirus disease 2019 patients in Malaysia during the first wave: A multi-center observational study (COVIDICU-MY).

Coronavirus disease 2019 (COVID-19) emerged with a wide range of clinical presentations; Malaysia was not spared from its impact. This study describes the clinical characteristics of COVID-19 patients admitted to intensive care unit, their clinical course, management, and hospital outcomes. COVIDICU-MY is a retrospective analysis of COVID-19 patients from 19 intensive care units (ICU) across Malaysia from 1 March 2020 to 31 May 2020. We collected epidemiological history, demographics, clinical comorbidities, laboratory investigations, respiratory and hemodynamic values, management, length of stay and survival status. We compared these variables between survival and non-survival groups. A total of 170 critically ill patients were included, with 77% above 50 years of age [median age 60, IQR (51-66)] and 75.3% male. Hypertension, diabetes mellitus, hyperlipidemia, chronic cardiac disease, and chronic kidney disease were most common among patients. A high Simplified Acute Physiology Score (SAPS) II score [median 45, IQR (34-49)] and Sequential Organ Failure Assessment (SOFA) score [median 8, IQR (6-11)] were associated with mortality. Patients were profoundly hypoxic with a median lowest PaO2/FiO2 ratio of 150 (IQR 99-220) at admission. 91 patients (53.5%) required intubation on their first day of admission, out of which 38 died (73.1% of the hospital non-survivors). Our sample had more patients with moderate Acute Respiratory Distress Syndrome (ARDS), 58 patients (43.9%), compared to severe ARDS, 33 patients (25%); with both ARDS classification groups contributing to 25 patients (54.4%) and 11 patients (23.9%) of the non-survival group, respectively. Cumulative fluid balance over 24 h was higher in the non-survival group with significant differences on Day 3 (1,953 vs. 622 ml, p < 0.05) and Day 7 of ICU (3,485 vs. 830 ml, p < 0.05). Patients with high serum creatinine, urea, lactate dehydrogenase, aspartate aminotransferase and d-dimer, and low lymphocyte count throughout the stay also had a higher risk of mortality. The hospital mortality rate was 30.6% in our sample. We report high mortality amongst critically ill patients in intensive care units in Malaysia, at 30.6%, during the March to May 2020 period. High admission SAPS II and SOFA, and severe hypoxemia and high cumulative fluid balance were associated with mortality. Higher creatinine, urea, lactate dehydrogenase, aspartate aminotransferase and d-dimer, and lymphopenia were observed in the non-survival group.

Airway involvement and mechanical ventilation in Steven Johnson Syndrome and Toxic Epidermal Necrolysis management

Steven-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe drug allergic reactions characterized by skin and mucosal membrane detachments. Most of the literature focuses only on the skin and ocular mucosal damage, but more severe and life-threatening mucosal damage may actually occur in the respiratory tract. This airway involvement may cause an acute complication, e.g. acute respiratory failure, and chronic complications, e.g. bronchiolitis organizing pneumonia, bronchiectasis, and restrictive bronchiolitis. The presence of airway involvement in SJS/TEN requires a more detailed examination, ranging from examination of the ear, nose, and throat (ENT), to fiberoptic bronchoscopy done by a skilled clinician to determine the presence of bronchial epithelial detachment. A higher percentage of skin and mucosal detachment is associated with a greater need for mechanical ventilation. Male sex, age, low serum bicarbonate, high serum urea, and higher amount of infiltrate on chest X-rays are also associated with a higher risk for mechanical ventilation in patients with SJS/TEN. The general indications for intubation and mechanical ventilation in patients with SJS/TEN are respiratory failures, inability to clear the airway, shock, neurologic disorder, and uncontrollable pain. More specific indications for intubation and mechanical ventilation are oral involvement with an initial total body surface area (TBSA) during hospital admission was ≥70%, or progression of TBSA ≥15% in the first 3 days of hospitalization, or neurological disorders, or documented airway involvement based on direct laryngoscopy examination.

A Cross-Sectional Study of Various Imaging and Biochemical Biomarkers in Patients with Diabetic Macular Edema in Different Stages of Diabetic Retinopathy.

PurposeTo compare which imaging and biochemical biomarkers are associated with different stages of diabetic retinopathy (DR) in type 2 diabetes mellitus patients with diabetic macular edema (DME).Patients and MethodsIt was a cross-sectional, observational study that included 100 patients of DME with different stages of DR. Patients were divided into two groups: Group A – DME with non-proliferative diabetic retinopathy (NPDR) and Group B - DME with proliferative diabetic retinopathy (PDR). Group A was further subdivided into three subgroups: A (1) – DME with mild NPDR, A (2) – DME with moderate NPDR, and A (3) – DME with severe NPDR. The primary outcome measure was the association of imaging and biochemical biomarkers with different stages of DR in patients with DME.ResultsOut of 100 patients, Group A (1) had 1, Group A (2) 44, Group A (3) 29, and group: B had 29 patients. As Group A (1) had only one patient, we did not include it in the calculation. The overall mean age of the study population was 54.84+9.87 years, with a male preponderance (76%). The HbA1c levels, serum triglyceride level, serum cholesterol level, and microalbuminuria level showed no significant association with different stages of DR (P>0.05). Still, we found high serum urea levels (p=0.027) in Group B patients. The optical coherence tomography (OCT)-based imaging biomarkers – central subfield thickness (CST), cystoid macular edema (CME), subretinal fluid (SRF), and hyperreflective foci (HRF) – showed no significant association with various stages of DR. The presence of diffuse retinal thickness (DRT) (p=0.04) and the epiretinal membrane (ERM) (p=0.04) showed significant association with Group B patients.ConclusionThe essential biochemical biomarkers such as serum urea levels and DRT and ERM may be considered an important imaging biomarker for the advanced stage of DR.

MO892: Depression and Symptom Burden in Patients on Chronic Haemodialysis

Abstract BACKGROUND AND AIMS Expanding complexity of the comorbid disorders is becoming increasingly common in patients treated with chronic haemodialysis (HD) related to technique improvements, better treatment options and resultant prolonged survival. This contributes to development of physical and emotional symptoms, which further affect patients’ health. We aimed to examine the symptom burden, symptom severity and prevalence of depression in patients treated with chronic HD. METHOD Three hundred and four chronic adult HD patients (58.9% males, 67.1% under 65 years of age, 15.7% with diabetes, time on dialysis 3—324 months) from five dialysis centrrs were enrolled in this cross-sectional study. All patients were under stable condition, without any severe acute comorbidities, and able to understand and fill-in the self-administered questionnaires. Standard laboratory parameters and Kt/V were measured in all patients. Presence and severity of physical and emotional symptoms were assessed by the 30-item Dialysis Symptom Index (DSI), while the presence of depression was assessed with Beck Depression Inventory (BDI). Other relevant demographic and clinical data were obtained from patients’ medical records. The results were analyzed with independent sample T-test, χ2 and ANOVA statistic. RESULTS The average BDI was 15.10 ± 11.04, the average symptom burden 15.49 ± 12.85 and the average symptom severity 23.38 ± 18.78. Nearly half of the patients (45.1%) had depressive symptoms (BDI ≥ 14). The demographic (sex, age, marital status, level of education, employment status, smoking habit), clinical (body mass index, comorbidities, dialysis vintage, shift and adequacy, type of membrane and vascular access) were not significantly associated with depression. Patients with depressive symptoms had significantly higher serum urea (24.5 ± 5.5 mmol/L versus 22.7 ± 5.4 mmol/L; P = 0.028) and creatinine (896.7 ± 196.2 umol/L versus 809.5 ± 206.4 umol/L; P = 0.003), but no significant difference in other standard laboratory measurements. Women, patients &amp;gt;65 and diabetic patients had significantly higher symptom burden than men, younger and non-diabetic patients (17.50 ± 12.88 versus 14.08 ± 11.68, P = 0.017; 18.65 ± 15.47 versus 13.94 ± 10.04, P = 0.002; 22.80 ± 18.75 versus 14.32 ± 10.39, P = 0.017, respectively), while diabetic and patients with inadequate dialysis had siginifcantly higher symptom severity (29.65 ± 21.69 versus 22.37 ± 18.26, P &amp;lt; 0.01 and 27.33 ± 20.70 versus 17.37 ± 14.62, P &amp;lt; 0.01, respectively). Depressive patients had significantly higher symptom burden (19.68 ± 13.29 versus 12.04 ± 10.20; P &amp;lt; 0.01) and symptom severity (31.92 ± 19.71 versus 16.37 ± 14.69; P &amp;lt; 0.01). The symptoms significantly more prevalent in depressive patients included constipation, nausea, diarrhoea, muscle cramps, restless legs, numbness/tingling in feet, lack of energy, bone/joint pain, dry mouth (all P &amp;lt; 0.001), shortness of breath (P = 0.036), dizziness (P = 0.048) and chest pain (P = 0.027). CONCLUSION These results highlight the need for routine surveillance of symptoms and emotional status in chronic HD patients.

Predictors of high flow oxygen therapy failure in COVID-19-related severe hypoxemic respiratory failure.

BackgroundDuring COVID-19 pandemic, people who developed pneumonia and needed supplemental oxygen, where treated with low-flow oxygen therapy systems and non-invasive methods, including oxygen therapy using high flow nasal cannula (HFNC) and the application of bi-level or continuous positive airway pressure (BiPAP or CPAP). We aimed to investigate the outcomes of critical COVID-19 patients treated with HFNC and unveil predictors of HFNC failure.MethodsWe retrospectively enrolled patients admitted to COVID-19 wards and treated with HFNC for COVID-19-related severe hypoxemic respiratory failure. The primary outcome of this study was treatment failure, such as the composite of intubation or death during hospital stay. The association between treatment failure and clinical features was evaluated using logistic regression models.ResultsOne hundred thirty-two patients with a median (IQR) PaO2/FiO2 ratio 96 (63–173) mmHg at HFNC initiation were studied. Overall, 45.4% of the patients were intubated. Hospital mortality was 31.8%. Treatment failure (intubation or death) occurred in 50.75% and after adjustment for age, gender, Charlson Comorbidity index (CCI) score and National Early Warning Score 2 (NEWS2) score on admission and PaO2/FiO2 ratio and acute respiratory distress syndrome (ARDS) severity at the time of HFNO initiation, it was significantly associated with the presence of dyspnea [adjusted OR 2.48 (95% CI: 1.01–6.12)], and higher Urea serum levels [adjusted OR 1.25 (95% CI: 1.03–1.51) mg/dL].ConclusionsHFNC treatment was successful in almost half of the patients with severe COVID-19-related acute hypoxemic respiratory failure (AHRF). The presence of dyspnea and high serum Urea levels on admission are closely related to HFNC failure.

Laboratory parameters associated with prolonged hospital length of stay in COVID-19 patients in Johannesburg, South Africa

Background. Coronavirus disease (COVID-19) has imposed unprecedented stressors on South Africa (SA)’s healthcare system. Superimposed on the country’s quadruple burden of disease, pandemic-related care further exposes existing inequities. Some of these inequities are specific to hospital-based inpatient services, such as the geographical maldistribution of hospital beds, lack of oxygen supplies and assisted ventilation, and scarcity of trained healthcare workers. Certain high-risk groups, such as individuals with cardiometabolic comorbidity, are likely to develop severe COVID-19 disease requiring hospitalisation with potential for a prolonged length of stay (LoS). It may be helpful for health authorities to identify those at risk for prolonged LoS to facilitate appropriate health systems planning. Objectives. To identify hospital admission laboratory parameters associated with a hospital stay &gt;14 days in patients with COVID-19 pneumonia. Methods. A retrospective observational study design was used. Laboratory data were obtained from an SA private laboratory for 642 inpatients with suspected or confirmed COVID-19 pneumonia, comprising 7 months of admission laboratory data from six private hospitals in Johannesburg, Gauteng Province. Results. Of 642 hospital admissions for pneumonia, 497 were confirmed to have COVID-19 infection (reverse transcription-polymerase chain reaction test positive). In the COVID-19-positive group, hospital LoS was prolonged in 35.4% of admissions. Univariate analysis demonstrated an association with the following risk factors for prolonged LoS: older age; male sex; high serum creatinine, sodium (Na), chloride, potassium and urea levels and low estimated glomerular filtration rate; raised white blood cell count, lymphopenia, neutrophilia and an elevated neutrophil-to-lymphocyte ratio (NLR); and elevated levels of D-dimers, interleukin-6 (IL-6), and procalcitonin (PCT). The strongest univariate associations (relative risk (RR) ≥2.0) with a hospital stay &gt;14 days were high Na levels, NRL &gt;18, high PCT levels and IL-6 &gt;40 pg/mL. On multivariable analysis, the following factors remained significantly associated with prolonged LoS: older age (RR 1.015 per year of age; 95% confidence interval (CI) 1.005 - 1.024); hypernatraemia (RR 1.80; 95% CI 1.25 - 2.60); hyperkalaemia (RR 1.61; 95% CI 1.18 - 2.20); and neutrophilia (RR 1.47; 95% CI 1.15 - 1.88). Conclusions. COVID-19 pandemic preparedness requires hospital-based inpatient care to be prioritised in resource-limited settings, and availability of beds and prompt admissions are essential to ensure good clinical outcomes. In this study of COVID-19 patients admitted with pneumonia, multivariable analysis showed older age, hypernatraemia, hyperkalaemia and neutrophilia to be associated with LoS &gt;14 days. This may assist with healthcare systems planning.

Evaluation of acute and chronic nephrotoxicity in patients received cisplatin-based chemotherapy: has anything changed over time?

The aim of this study was to determine the frequency and the risk factors of acute and chronic nephrotoxicity in patients who received cisplatin due to malignancy. Medical records of all patients who received cisplatin-based chemotherapy regimen between January 2013 and July 2019 were retrospectively evaluated. The data of 203 patients who met the study criteria were examined. The patients were evaluated for acute nephrotoxicity at 48h and late nephrotoxicity at 3rd month after first course of cisplatin. Early and late nephrotoxicity were defined by NCI CTCAE Version 4.0 criteria. The mean age of the study patients was 56.44 ± 12.69years, 78.8% were males and 21.2% were females. It is revealed that the incidence of cisplatin-induced acute nephrotoxicity was 9.2% and chronic nephrotoxicity was 37.9%. While the development of acute nephrotoxicity was associatedwith female gender, history of diabetes mellitus, history of ischemic heart disease and use of antiplatelet drug, the development of chronic nephrotoxicity was associatedwith older age, female gender and using of diuretics. High serum creatinine, urea and low eGFR value before treatment were found to be associated with both early and late nephrotoxicity (p < 0.05). There was no statistically significant relationship between acute or chronic nephrotoxicity and cumulative dose of cisplatin, hydration or intravenous magnesium supplementation. High initial serum creatinine value and low initial eGFR are the most important determinants of both early and late nephrotoxicity.

The Related Factors of Hyperuricemia in IgA Nephropathy

Many factors, such as increased serum creatinine, increased blood pressure and abnormal urine protein, may lead to poor prognosis of IgA nephropathy (IgAN). The features of IgAN are also affected by uric acid, but its effect on the prognosis is less reported. We therefore systematically investigated the possible correlation of IgAN with hyperuricemia (HUA) and their prognosis. Two groups (HUA group and uric acid normal group) were included of 178 IgAN patients. The indexes in the clinic and pathology were compared; logistic regression and renal survival were used to speculate the correlated factors of HUA in IgAN and their prognosis. HUA group had higher serum urea nitrogen, serum creatinine, total cholesterol, 24-hour urinary protein quantity, percentage of CKD3⁃5, the thickness of arteriole, glomerular mesangial hyperplasia, tubular atrophy, glomerulosclerosis, interstitial fibrosis and the area of infiltration of inflammatory cells (ICI), lower eGFR and serum albumin-to-creatinine ratios (P < .05). Total cholesterol and ICI in X2 were independent related factors of HUA given by the analysis of logistic regression (P < .05). No correlation was found in HUA and normal group used by Kaplan- Meier (P > .05). Severer renal pathological injures (glomeruli, tubules or interstitium) were found in IgAN. Besides, total cholesterol and the area of infiltration of inflammatory cells were independent related factors of hyperuricemia in IgAN.

Intact Higher Mental Functions Despite High Serum Urea and Creatinine Levels in a Patient with Acute Kidney Injury: A Case Report.

Intact Higher Mental Functions Despite High Serum Urea and Creatinine Levels in a Patient with Acute Kidney Injury: A Case Report.

Serum biochemical reference ranges for pregnant sheep

Late pregnancy is accompanied by dramatic changes in the metabolism of sheep, in which the nutrient requirements increase and the metabolic capacity of ewes is under severe stress due to the rapid foetal growth and development of the mammary gland. The blood metabolic profile can be used to monitor these alterations, which can lead to metabolic disorders such as pregnancy toxaemia. However, data available on serum parameters in sheep do not consider physiological state. Therefore, the present study aimed to determine the biochemical reference ranges for pregnant ewes, including serum energy, protein and enzyme-related metabolites. Data from a variety of metabolites were obtained from experiments performed in several institutions and commercial farms using Santa Inês, Dorper, Lacaune, Morada Nova, Bergamacia and Suffolk ewes reared under different conditions (grazing, feedlot, semi-feedlot, collective and/or individual pens, and metabolic cages) from 2006 to 2017. All animals were healthy and without feed restriction. Data from ewes with any clinical manifestations were removed. The metabolic energy profile included data of glucose, cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein and very-low-density lipoprotein levels; the metabolic protein profile included the metabolites total protein, uric acid, urea, albumin, and creatinine; and the metabolic enzymatic profile included the enzymes aspartate aminotransferase, gamma-glutamyl transferase and alkaline phosphatase. The reference ranges were estimated using the software RefVal 4.11. Dixon’s test was used to identify and remove outliers. The confidence intervals and percentiles were estimated using the nonparametric method of bootstrap when data were not normally distributed. A 95% confidence level was used. The serum biochemical reference ranges for pregnant sheep determined in our study were strongly divergent from those established by one of the most cited books on the topic, especially considering the high serum urea and cholesterol concentrations and low levels of blood glucose observed. Therefore, it is essential to consider physiological status when evaluating the blood metabolic profile of pregnant ewes in order to maintain an adequate nutritional management and to prevent health disorders that may lead to productive and reproductive losses.

Impact of Dialysis Vintage and Renal Biomarkers on Mortality in Dialysis-Dependent Patients With Critical Limb Ischemia Undergoing Revascularization

Purpose: Revascularization of both endovascular therapy (EVT) and surgical reconstruction improve clinical outcomes of patients with critical limb ischemia (CLI); however, treatment of dialysis-dependent patients with CLI is still challenging. This study aimed to investigate the impact of dialysis-related parameters on the risk of mortality in dialysis-dependent patients undergoing revascularization for CLI. Materials and Methods: We retrospectively identified 274 dialysis-dependent patients with CLI (196 males; mean age 71 years), who underwent revascularization, from the clinical database of the surgical reconstruction vs peripheral intervention in patients with critical limb ischemia (SPINACH) study, which was a prospective, multicenter, observational study. Of these patients, 175 patients underwent EVT and 99 patients received surgical reconstruction. The current study evaluated the impact of dialysis vintage and renal biomarkers on the mortality rate of dialysis-dependent patients with CLI undergoing revascularization. Results: During a mean follow-up period of 1.7 ± 1.1 years, 147 deaths were observed. The 3-year overall survival rate and its standard error were estimated to be 40.5% ± 8.1% using the Kaplan-Meier method. A Cox proportional hazard analysis revealed that dialysis vintage ≥4 years, serum creatinine levels <4.7 mg/dL, serum urea nitrogen ≥88 mg/dL, and calcium-phosphate product ≥62.6 mg2/dL2 were independent risk factors for mortality after adjustment for the detailed mortality risk score developed in the SPINACH study. Adding these parameters to the original mortality risk score slightly, but not significantly, increased the area under the time-dependent receiver operating characteristics curve from 0.74 (95% CI, 0.67 to 0.81) to 0.77 (0.71 to 0.84) (p=0.084), whereas continuous net reclassification improvement reached 0.75 (0.12 to 0.90) (p=0.027). Conclusion: We found that long dialysis vintage, low serum creatinine, high serum urea nitrogen, and high calcium-phosphate product were independently associated with the increased risk of mortality in dialysis-dependent patients with CLI undergoing revascularization.

Persistence and Severity of Cutaneous Manifestations in IgA Vasculitis Is Associated with Development of IgA Vasculitis Nephritis in Children

Background/Objective: The purpose of this study was to evaluate the prevalence and severity of skin involvement in children with IgA vasculitis (IgAV) and its relationship with clinical and biochemical parameters and the risk of developing IgA vasculitis nephritis (IgAVN), the only cause of long-term morbidity and the main prognostic factor in IgAV patients. Methods: This national multicenter retrospective study included 611 patients under the age of 18 years with IgAV referred to five Croatian tertiary hospitals between 2009 and 2019. Patient data were collected from a database with systematic analysis of IgAV patients in the Croatian population. Results: Among the 611 children, 205 (33.55%) had purpura on the lower extremities, in 207 (33.88%) the rash extended on the trunk, in 149 (24.39%) it extended to the upper extremities, in 32 (5.24%) the rash was generalized, while 15 (2.47%) had the most severe skin symptoms: bullae, ulcerations, and necroses. IgAVN developed in 130 (21.28%) and persistent IgAVN (present for >3 months) in 48 (7.86%) children. Multivariate logistic regression found that presence of ulcerations and necroses (OR 3.20 [95% CI 1.03–9.91]), persistent purpura (OR 2.89 [95% CI 1.71–4.88]), and higher age (OR 1.16 [95% CI 1.09–1.23]) were significant predictors of IgAVN, whereas persistent purpura (OR 20.11 [95% CI 1.09–372.52]), male sex (OR 3.32 [95% CI 1.13–9.80]), and higher age (OR 1.15 [95% CI 1.00–1.30]) were predictors of persistent IgAVN. Among the laboratory parameters, higher serum urea (OR 1.43 [95% CI 1.03–2.00]) and reduction in activated partial thromboplastin time (OR 0.83 [95% CI 0.74–0.93]) were shown to have a significant impact on increasing the risk of persistent IgAVN. Conclusion: With increasing severity and duration of cutaneous manifestations in IgAV, the risk of developing IgAVN increases, making the prognosis worse, with a greater likelihood to need more aggressive treatment.

Maternal Supplementation with Cow's Milk Naturally Enriched with PUFA Alters the Metabolism of Sows and the Fatty Acid Profile of the Offspring.

The study aimed to evaluate the supplementation of gilts with cow’s milk naturally enriched with n-3 and n-6 polyunsaturated fatty acids (PUFA) on reproductive outcomes, and the serum biochemical and FA profile of swine females and their offspring. During 316 days, 30 gilts were distributed into three groups: (1) Control, fed a basal diet + milk from cows without oil; (2) n-3, fed a basal diet + milk from cows fed a diet enriched with linseed oil; (3) n-6, fed a basal diet + milk from cows fed a diet enriched with soybean oil. The gilts receiving the diets containing PUFA had higher serum urea and very-low-density lipoprotein levels and lower serum total protein and low-density lipoprotein levels compared to the Control group. Females supplemented with n-3 presented higher serum palmitic acid and γ-linolenic acid levels than those fed n-6. Piglets from the Control group were heavier at birth than those from females supplemented with enriched milk. The piglets from females receiving enriched milk had 140 g higher body weight from 1 to 21 days old compared to the Control group, and greater average daily weight gain from 7 to 14 days old. The serum eicosapentaenoic acid level of piglets fed n-3 was 69% higher than those fed n-6, which reduced the AA/EPA ratio. Gilts supplemented with PUFA-enriched cow’s milk showed changes in their serum palmitic and γ-linolenic acid levels, in addition to improved performance, EPA concentration and consequently reduced AA/EPA ratio in their piglets, demonstrating beneficial results for their progeny.

MO390THE RISK FACTORS AND CLINICAL OUTCOMES ASSOCIATED WITH ACUTE KIDNEY INJURY IN PATIENTS WITH COVID-19

Background and AimsKidney involvement, ranging from mild hematuria and proteinuria to acute kidney injury (AKI) in patients with coronavirus disease-2019 (COVID-19), is a recent finding with various incidence rates reported among hospitalized patients with COVID-19. Current evidence on AKI rate in patients hospitalized with COVID-19 and its associated risk factors is limited, especially in Iran.MethodIn this retrospective cohort study, we enrolled adult patients referred to the Sina hospital, Iran, from 20 February to 14 May 2020, with either a positive PCR test or a highly susceptible chest computed tomography features (CT) consistent with COVID-19 diagnosis. AKI was defined according to the kidney disease improving global outcomes (KDIGO) criteria, and patients were stratified based on their AKI staging. We evaluated the risk indicators associated with AKI during hospitalization besides in-hospital outcomes and recovery rate at the time of discharge.Results: We evaluated 516 patients with a mean age of 57.6±16.1 years and a male to female ratio of 1.69 who were admitted with the COVID-19 diagnosis. AKI development was observed among 194 (37.6%) patients, comprised of 61.9% patients in stage 1, 18.0% in stage 2, and 20.1% in stage 3. Out of all patients, AKI occurred in 58 (11.2%) patients during the hospital course, and 136 (26.3%) patients arrived with AKI upon admission. AKI development was positively associated with all of the in-hospital outcomes, including intensive care unit admissions, need for invasive ventilation, acute respiratory distress syndrome (ARDS), acute cardiac injury, acute liver injury, multi-organ damage, and mortality. Patients with stage 3 AKI showed a significantly higher mortality rate, ARDS, and need for invasive ventilation than other stages. After multivariable analysis, male sex (odds ratio (OR):11.27), chronic kidney disease (OR: 6.89), history of hypertension (OR:1.69), disease severity (OR; 2.27), and high urea levels (OR: 1.04) on admission were independent risk indicators of AKI development. Among 117 (28.1%) patients who experienced AKI and survived, only 33 (28.2%) patients made a recovery from the AKI, and 84 (71.8%) patients did not exhibit full recovery at the time of discharge.ConclusionWe found that male sex, history of chronic kidney disease, hypertension, disease severity, and high serum urea were independent risk factors associated with AKI in patients with COVID-19. Also, higher stages of AKI were associated with increased risk of mortality and in-hospital complications. Our results indicate a necessity for more precise care and monitoring for AKI during hospitalization in patients with COVID-19, and lack of AKI recovery at the time of discharge is a common complication in such patients.