24-hour Urine Research Articles

A study of the difference in biochemical metabolism between patients with unilateral and bilateral upper urinary tract stones

Bilateral upper urinary tract stones are more likely to lead to impairment of renal function, but few biochemical metabolic studies of bilateral upper urinary tract stones have been reported. We collected clinical data from 555 patients with upper urinary tract stones admitted to Beijing Tsinghua Changgung Hospital from June 2020 to June 2024, and divided them into unilateral and bilateral stone groups by CT scans, analysed the metabolic differences between unilateral and bilateral stone groups by statistical methods, and used multifactorial logistic regression analysis to explore the risk factors that might affect the formation of bilateral stones. A total of 281 cases of unilateral and 274 cases of bilateral stones were identified. The proportion of male patients in the bilateral group was higher than that in the unilateral group (P < 0.05). The most prevalent major stone component was calcium oxalate monohydrate (48.1%), with a significantly higher prevalence of cystine stones observed in the bilateral stone group (1.8%) compared to the unilateral stone group (0.4%) (P < 0.05). Blood uric acid, blood BUN, blood creatinine, urine pH, and 24-hour urine output were higher in the bilateral stone group than in the unilateral group (P < 0.05). The most prevalent metabolic abnormality was low urine volume (45.7%). Bilateral stone group had higher proportion of patients with hyperuricemia (P < 0.05). The results of the multivariate logistic regression analysis showed that male gender (OR 1.489, 95% CI 1.028–2.157) and hyperuricemia (OR 1.662, 95% CI 1.113–2.482) were associated with an increased risk of bilateral stone formation (P < 0.05). There are significant differences in biochemical metabolism between unilateral and bilateral upper urinary tract stones. The most common metabolic abnormality in patients with urolithiasis is low urine output, and aggressive water intake is effective in preventing stone formation. For patients with hyperuricemia, a strict dietary regimen is imperative to mitigate the likelihood of bilateral stone formation.

Clinicopathological characteristics of patients with low titer anti-phospholipase A2 receptor antibodies verified by indirect immunofluorescence assay

ObjectiveLaboratory extensively applied enzyme-linked immunosorbent assay (ELISA) to measure anti-phospholipase A2 receptor antibodies (PLA2R-abs) since its diagnostic significance on PLA2R related primary membranous nephropathy (PLA2R-related pMN) was discovered. However, PLA2R-abs determined by ELISA (PLA2R-ELISA) could infrequently yield inconclusive results, specifically a grey-zone defined as PLA2R-abs ranging from 2 to 20 RU/mL. Recently, researchers suggested that double-check grey-zone PLA2R-abs by indirect immunofluorescence (IIF) could improve diagnostic accuracy. We evaluated the diagnostic performance of PLA2R-IIF in assessing PLA2R-related pMN and summarized clinicopathological characteristics of grey-zone population to provide more evidence for clinical practice. MethodsData on demographics, serology and pathology of patients with PLA2R-ELISA grey-zone results and a native kidney biopsy at Peking Union Medical College Hospital from September 2020 to April 2023 were reviewed. Grey-zone samples were analyzed using PLA2R-IIF. Negative results were defined as no fluorescence and positive results were graded according to fluorescence intensity. ResultsThis study included a total of 52 grey-zone patients divided into pMN group (n = 36, 69 %) and non-pMN group (n = 16, 31 %) according to renal pathology reports. pMN patients had higher PLA2R-abs and lower serum creatinine compared to the non-pMN patients (P = 0.003, P < 0.001). No statistically significant differences were observed in 24-hour urine protein and albumin between the two groups. Multiple pathological types were identified in the non-pMN group. The sensitivity and specificity of PLA2R-IIF in PLA2R-ELISA grey-zone population were 72 % and 88 %, respectively, with a total consistent rate of 77 % and a positive predictive value of 93 %. ConclusionBoth pMN and non-pMN patients presented grey-zone PLA2R-ELISA results. It was necessary to perform PLA2R-IIF to assist in the diagnosis of patients with PLA2R-ELISA grey-zone results.

Relationship between IgM deposition in the mesangial region and the prognosis of IgA nephropathy: a single-centre retrospective study

ObjectiveThe aim of this study was to investigate the prognostic value of mesangial IgM deposition in a long-term follow-up cohort of patients with immunoglobulin A nephropathy (IgAN).MethodsA retrospective analysis of clinicopathological data from 774 patients with primary IgAN at Hangzhou Hospital of Traditional Chinese Medicine between January 1, 2016, and December 31, 2018, was conducted. Patients were categorized into end-event and non-end-event groups according to whether they reached the renal composite endpoint, defined as a ≥ 50% decline in eGFR or progression to end-stage renal disease (ESRD). Risk factors for adverse renal outcomes were evaluated via univariate and multivariate Cox regression models. Patients were further divided into three groups on the basis of IgM deposition levels in the glomerular mesangial area: IgM-negative, low (IF < 2+), and high (IF ≥ 2+). Comparative analyses of clinical and histopathological characteristics, along with treatment regimens, were performed across these groups.ResultsCompared with the IgM-negative and low-deposition groups, the high-IgM deposition group exhibited significantly lower serum albumin and eGFR levels and higher cholesterol, 24-hour urine protein, and blood immunoglobulin M levels. Multivariate Cox regression analysis identified immunosuppressant use as an independent protective factor for IgAN prognosis, whereas low serum albumin, T2 lesions, and nephropathological IgM deposits were recognized as independent risk factors for the 5-year prognosis of patients with IgAN. Kaplan‒Meier survival curves revealed that patients with high IgM deposition had markedly poorer prognoses than those with negative or low IgM deposition.ConclusionIn addition to low serum albumin and T2 lesions, IgM deposition in the mesangial region has emerged as an independent risk factor for the 5-year prognosis of patients with IgAN.

Efficacy of acupuncture for pregnancy with early-onset ovarian hyperstimulation syndrome: study protocol for a randomised controlled clinical trial

IntroductionAlthough ovarian hyperstimulation syndrome (OHSS) is a common complication primarily seen in patients undergoing in vitro fertilisation-embryo transfer, there is no recognised effective treatment to manage it, especially for pregnant...

Association between 24-hour urine volume and 28-day intensive care unit mortality in sepsis patients: a multi-center retrospective cohort study

BackgroundSepsis is defined as a dysregulated host response to infection that results in life-threatening organ dysfunction. The 24-hour urine volume plays a crucial role in assessing the prognosis of septic patients. This study aims to investigate the relationship between 24-hour urine volume and 28-day intensive care unit (ICU) mortality in septic patients and exploring the dose-response relationship between these variables.MethodsThis retrospective cohort study analyzed data from 7,218 sepsis patients in the eICU Collaborative Research Database. Logistic regression models and generalized additive models were used to examine the relationship between 24-hour urine volume and 28-day ICU mortality.ResultsA negative correlation was found between 24-hour urine volume and ICU 28-day mortality. In the fully adjusted model, each 50 mL increase in 24-hour urine volume significantly reduced mortality risk by 1% (OR = 0.99, 95% CI = 0.98–0.99, P &amp;lt; 0.001). A nonlinear dose-response relationship was observed, with an inflection point at ~1,663.5 ml. Below this threshold, increased urine volume was significantly associated with reduced mortality risk (OR = 0.97, 95% CI: 0.96–0.98, P &amp;lt; 0.001), while above this point, the relationship was not statistically significant.ConclusionThis study demonstrates a non-linear negative correlation between 24-hour urine volume and 28-day ICU mortality in sepsis patients.

Ershen Zhenwu Decoction Suppresses Myocardial Fibrosis of Chronic Heart Failure with Heart–Kidney Yang Deficiency by Down-Regulating the Ras Homolog Gene Family Member A/Rho-Associated Coiled-Coil Kinases Signaling Pathway

Ethnopharmacological significanceThe therapeutic efficacy of Ershen Zhenwu Decoction (ESZWD)—a famous formulation from Xin’an for patients with chronic heart failure heart–kidney Yang deficiency (CHF-HKYD)—is well established. Still, the underlying molecular mechanism is not clear. Aim of the studyThis study investigated mechanisms by which ESZWD suppresses cardiac pathology, including myocardial fibrosis, in CHF-HKYD model rats and Ang II-stimulated cardiac fibroblasts (CFs). Materials and methodsThe components in ESZWD were analyzed by ultra-high-performance liquid chromatography coupled with Quadrupole Time-Of-Flight mass spectrometry (UHPLC-Q-TOF-MS). CHF-HKYD model was established in the male Sprague–Dawley rats through bilateral thyroidectomy and intraperitoneal administration of 0.02% doxorubicin (DOX), twice weekly for 3 weeks. Subsequently, the CHF-HKYD model rats were randomly categorized into the Model, ESZWD-L (3.96 g/kg/d ESZWD), ESZWD-M (7.92 g/kg/d ESZWD), ESZWD-H (15.84 g/kg/d ESZWD), and Sac/Val (68 mg/kg/d sacubitril/valsartan) groups and treated daily for 4 weeks. As a control, the sham surgery group (Sham) was used. Primary cardiac fibroblasts (CFs) were categorized into Control, Model, ESZWD, and Sac/Val groups. Then, the CFs were stimulated with Ang-II. The ESZWD and Sac/Val groups were incubated with different concentrations of drug-containing sera and their effects on CF viability were assessed via the CCK-8 assay. The ESZWD and Sac/Val groups received drug-containing serum concentrations determined by CCK-8 assay results. The cardioprotective effects of ESZWD were determined using echocardiography, Hematoxylin & Eosin (H&E) staining, Masson staining, and Sirius red staining, and the Enzyme Linked Immunosorbent Assay (ELISA). ESZWD's effects on the Ras Homolog Gene Family Member A (RhoA) / Rho-Associated Coiled-Coil Kinases (ROCKs) signaling pathway and myocardial fibrosis were assessed by Western blotting and Quantitative Real-Time PCR (qRT-PCR) analyses. Immunofluorescence was used to observe fibrotic markers in CFs. ResultsESZWD treatment improved cardiac function in the CHF-HKYD rats by significantly reducing myocardial fibrosis and ventricular remodeling. ESZWD treatment increased the rats' body temperature (Tb) and 24-hour urine volume, left ventricular ejection fraction (LVEF) and LV fractional shortening (LVFS), and decreased LV internal systolic diameter (LVIDs), LV internal diastolic diameter (LVIDd), and heart weight/ body weight (HW/BW) compared to the Model group. In comparison to the model rats, ESZWD treatment decreased serum levels of B-type natriuretic peptide precursor (NT-proBNP), tumor necrosis factor-alpha (TNF-α), interleukin-11 (IL-11), and IL-17A. ESZWD treatment significantly down-regulated the protein and mRNA expression levels of collagen I A1, α-SMA, RhoA, ROCK1, and ROCK2 in the heart tissues of the CHF-HKYD rats and the Ang II-stimulated CFs. ConclusionESZWD significantly improved cardiac function and attenuated myocardial fibrosis and inflammation in the CHF-HKYD rats by inhibiting the RhoA/ROCKs signaling pathway.

Primary hyperoxaluria: results of a retrospective survey of the diagnostic practices of nephrologists

Primary hyperoxalurias (PH) are rare and serious genetic diseases. Their prognosis is improved with early medical management. However, diagnosis often occurs at the end-stage of renal failure. To understand this delay, collecting real-world data on the clinical practices of nephrologists may be helpful. Between October 2021 and October 2022, a retrospective survey was conducted in France among 76 nephrologists to assess management practices for patients with chronic kidney disease (CKD) of unknown aetiology, associated with urinary lithiasis and/or nephrocalcinosis. Data on patient profiles, tests conducted, diagnoses considered, and management of suspected PH cases were collected. 97% of patients (n = 386/400) underwent a renal examination, 92% (n = 370/400) a thorough urinary check-up, and 65% (n = 260/400) had an interpretable oxaluria value from a 24-hour urine sample (Uox24h). Of these 260 patients, 50% (n = 130/260) had Uox24h > 500 µmol/24 h: 23% (n = 30/130) were suspected of PH by the nephrologists, and 15% (n = 19/130) were referred for genotyping. Considering all criteria, 52 patients were suspected of PH (42% of whom did not have Uox24h > 500 µmol/24 h), and 33% (n = 17/52) were not referred for genotyping. The survey highlights nephrologists' adherence to recommendations for prescribing biological tests. However, in cases of hyperoxaluria or suspected PH, genotyping was not always prescribed. The barriers to this prescription need further exploration.

Unprecedented Co-occurrence: Identification of a Pathogenic Genetic Variant in the KMT2B Gene in a Wilson Disease Patient with a Pathogenic ATP7B Mutation

The pathophysiology of dystonia in Wilson disease (WD) is complex and poorly understood. Copper accumulation in the basal ganglia, disrupts dopaminergic pathways, contributing to dystonia’s development via neurotransmitter imbalance. Despite advances in diagnosis and management, WD with dystonia remains a challenging condition to treat. We aim to report the unprecedented co-occurrence of pathogenic genetic variants in both the ATP7B and KMT2B genes in a patient with WD. A 13-year-old male presented at 12 with dysarthria and bilateral Kayser-Fleischer rings. Over months, dystonia spread to his left foot, upper limb, and trunk, accompanied by slowed daily activities. Diagnostic tests included MRI for brain structure, abdominal ultrasound for liver function, serum ceruloplasmin and copper levels to assess copper metabolism, and 24-hour urine copper tests for excretion levels. Whole exome sequencing was conducted using genomic DNA from peripheral blood samples. Variant classification followed guidelines from the American College of Medical Genetics and Genomics. The sequencing revealed compound heterozygous pathogenic variants in the ATP7B gene: NM_000053.4:c.2165dupT and NM_000053.4:c.813C&gt;A. A pathogenic variant in the KMT2B gene, NM_014727:c.3052delA, was identified. This case highlights WD co-occurrence with ATP7B and KMT2B mutations, suggesting KMT2B as a potential genetic modifier.

Ascorbic acid and glucose can cause significant interference on quantitative measurement of biochemistry analytes in urine.

Preanalytical errors due to interferences can lead to inaccurate results, necessitating an understanding of potential interferences for each test. This study explores the impact of elevated concentrations of ascorbic acid and glucose on urine analysis, a pivotal diagnostic tool. Conducted at the Clinical Institute of Chemistry, KBC Sestre milosrdnice, the research utilized a 24-hour urine sample. Parameters assessed included total proteins, albumin, amylase, sodium, potassium, chlorides, calcium, phosphates, magnesium, creatinine, urea, and uric acid. Various concentrations of added interferents were prepared for duplicate measurements using statistical analysis in Microsoft Excel. No statistically significant interferences were found in albumin, amylase, sodium, potassium, or phosphate concentrations. However, ascorbic acid interfered with chloride, calcium, and magnesium determinations. Conversely, elevated glucose affected total protein, calcium, magnesium, creatinine, urea, and uric acid determinations. Interference of ascorbic acid with chloride and interference of glucose with total proteins and uric acid displayed a linear relationship. Results suggest cautious analysis interpretation from certain parameters in patients with elevated glucose and/or ascorbic acid in urine. Whereas ascorbic acid interference may go unnoticed due to its infrequent measurement, routine determination of glucose in urine is crucial, especially for diabetes patients.

The diagnostic utility of urinary Transferrin excretion rate as predictor for micro albuminuria in patients with Type 2 Diabetes Mellitus among Karbala province

One of the factors responsible of end-stage renal disease and chronic kidney disease is diabetic nephropathy. Microalbuminuria itself is regarded as the initial indication of diabetic nephropathy, and it affects 20% to 40% of patients with diabetes mellitus. Because of the limited accuracy and precision of microalbuminuria, more susceptible markers may be developed to more accurately identify diabetic nephropathy early on. The purpose of this research was to ascertain whether urine transferrin could be used as a marker for diabetic nephropathy. In our research, 80 subjects with type 2 diabetes were divided into two categories: 10 healthy controls and group 1 (normoalbuminuric, with albumin excretion up to 30 mg/d) and group 2 (microalbuminuric, with albumin excretion between 30 and 300 mg/d). all subjects was over the age of 18, had diabetes for further than a year, and had a glomerular filtration rate greater than 60 mL/min/1.73 m2. The concentration of transferrin, serum creatinine, and glycosylated hemoglobin (HbA1c) in both spot urine and 24-hour urine samples were assessed using a super accurate sandwich enzyme - linked immunosorbent assay kit. subjects with microalbuminuria had substantially greater urinary transferrin levels than both normoalbuminuric and healthy control participants. We discovered a significantly positive correlation r = 0.584 (p &lt; 0.001) when we compared these categories based on the urinary transferrin concentration. Urinary transferrin levels did not correlate with glycoregulation, and neither did transferrin levels and the length of diabetes. Urinary transferrin levels may be utilized as an important indicator of diabetic nephropathy, according to the findings of the research.

Combination of rituximab and low-dose glucocorticoids for idiopathic refractory nephrotic syndrome with MCD/FSGS: a single-center prospective cohort study

Background The treatment of idiopathic refractory nephrotic syndrome (IRNS) remains a difficult problem in clinical practice. This study aims to determine the efficacy and safety of combining low-dose glucocorticoids with rituximab in IRNS treatment. Methods This prospective, single-center cohort study enrolled 60 patients who were diagnosed with refractory IRNS with minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS) and treated at First Affiliated Hospital of Sun Yat-sen University. All patients received a treatment regimen consisting of rituximab (375 mg/m2/week × 4) and low-dose glucocorticoids. Results 46 complete remissions and 4 partial remissions were observed within 6 months of treatment. Within 12 months of treatment, 48 patients achieved complete remission, and 4 achieved partial remission. The complete remission rate for steroid-dependent/frequently relapsing nephrotic syndrome was significantly higher than that for steroid-resistant nephrotic syndrome (88.24% vs. 33.33%, p < .01). Following up for 12 months, 16 patients relapsed, accounting for 30.76% of the total, with a mean time to relapse of 10.97 months. Compared with baseline data, 24-hour urine protein quantification, total cholesterol and triglycerides significantly decreased, while serum albumin, globulin and IgG significantly increased at 12 months after treatment. All follow-ups were without serious adverse events. Twenty-four patients experienced infusion-related adverse reactions, which could be relieved by slowing down the infusion rate or suspending the infusion. Nine patients experienced infection-related adverse reactions; six of them were relieved with antibiotic treatment, and 3 patients were controlled by symptomatic treatment. Conclusions Rituximab combined low-dose glucocorticoids therapy is effective and safe in idiopathic refractory nephrotic syndrome.

Abstract 4140120: Artificial intelligence-driven morbidity prediction in acute kidney injury after acute type A aortic dissection surgery

Background: Acute kidney injury (AKI) often complicates acute type A aortic dissection (ATAAD), with elevated comorbidity rates and a significant tie to in-hospital mortality. Identifying risk factors early can mitigate AKI severity. Research Questions: This research endeavors to develop and corroborate predictive models leveraging Machine Learning (ML) techniques from Artificial Intelligence to forecast AKI occurrences in ATAAD-afflicted individuals. Methods: The study employed various machine learning (ML) algorithms including Gradient Boosting Machine (GBM), LightGBM, Random Forest (RF), K-Nearest Neighbors (KNN), Multi-Layer Perceptron Neural Network (MLP-NN), Naive Bayes (NB), Logistic Regression (LR), and ensemble methods (combining LR&amp;LightGBM), employing tenfold cross-validation. Model performance was evaluated using SHapley Additive exPlanations (SHAP). A web-based tool for predicting AKI incidence was developed using Streamlit, based on the most effective model. The analysis involved 1350 ATAAD patients, among whom 586 (43.4%) developed post-operative AKI. Patients were divided into two cohorts: 85% for training and 15% for testing, with 126 features included in the predictive model. Results: Incorporating top 10 features, LightGBM (AUROC=0.886, 95% CI 0.841-0.930) excelled in predictive accuracy, calibration, and clinical utility, identifying key factors such as ventilation time in ICU, hourly urine output post-surgery, diuretic use, Scr, heart rate, urea, administration of recombinant human brain natriuretic peptide and ebrantil, MCHC, and blood glucose as associated with ATAAD-AKI. Conclusion(s): These ML models are robust tools for predicting AKI in ATAAD patients, with LightGBM's superior predictive ability standing out. They offer valuable support for clinical decision-making in ATAAD management, helping optimize postoperative strategies to minimize AKI occurrence after surgery.

Correlation between Fundus Damage and Renal Function Deterioration in Chronic Kidney Disease Patients.

This study aimed to explore the correlation between the extent of fundus damage and the severity strategies for chronic kidney disease (CKD). We collected data from 118 CKD patients, including general information, renal function indicators, and fundoscopic examination results. The stages of CKD and degrees of fundus lesions were graded. SPSS 25.0 software facilitated the analysis of correlations using Kendall's tau-b correlation analysis and ordinal regression analysis. Statistically significant differences were observed among multiple CKD stages in the distribution of age, systolic blood pressure, diastolic blood pressure, hemoglobin, total cholesterol, homocysteine, cystatin C, serum creatinine, blood urea, eGFR, 24-hour urine protein, urine microalbumin, urine microalbumin/urine creatinine, and blood β2 microglobulin, complement C3. Notably, the levels of cytokeratin 19 fragment and transforming growth factor β significantly increased in all CKD stages. Kendall's tau-b correlation analysis revealed a significant positive correlation between CKD stage and fundus lesion grade. Ordinal regression analysis indicated that sex differences, total cholesterol levels, and hemoglobin levels were significant predictors of fundus lesion risk. Compared with patients at stage 5 CKD, the risk of fundus damage significantly lower in patients in stage 2 and stage 3, further demonstrating a positive correlation between renal function deterioration and increased risk of fundus damage. Routine fundus screening and early intervention for fundus lesions are vital for assessing CKD deterioration, providing new directions for future related research.

Gastrodin ameliorates diabetic nephropathy by activating the AMPK/Nrf2 pathway.

Diabetic nephropathy (DN) is a leading cause of end-stage kidney failure, contributing to elevated morbidity and mortality rates in individuals with diabetes. Despite its potential renoprotective effects, the molecular mechanism by which gastrodin (GSTD) impacts DN remains unclear. To investigate this, mice were initially induced with DN via intraperitoneal streptozotocin (STZ) injection (50mg/kg) and subsequently treated with varying doses of GSTD (5, 10, 20mg/kg). Furthermore, the potential molecular mechanism of GSTD in mitigating DN was explored in vivo in conjunction with compound C, an inhibitor of 5'-AMP-activated protein kinase (AMPK). Subsequently, the blood weight, fasting blood glucose levels, and renal injury markers of DN-afflicted mice were assessed. Additionally, renal tissues were subjected to quantitative reverse-transcriptase-polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA) to evaluate inflammatory factor levels, colorimetric assays to measure renal malondialdehyde (MDA) levels, and immunoblotting analysis to examine AMPK/nuclear factor erythroid 2-related factor 2 (Nrf2) pathway. The results demonstrated that a 6-week GSTD regimen effectively improved metabolic manifestations associated with DN, including reductions in fasting blood glucose levels, 24-hour urine output, renal indices, amelioration of glomerular histopathological abnormalities, diminished glycogen accumulation, and fibrosis. Furthermore, DN-afflicted renal tissues exhibited decreased MDA levels and elevated expression of AMPK/Nrf2 pathway-associated proteins. The beneficial effects of GSTD on DN and its protein modulation were reversed upon co-intervention with compound C. Together, our findings imply that GSTD improves DN by activating the AMPK/Nrf2 pathway, thereby mitigating STZ-induced renal damage, inflammatory responses, and oxidative stress.

Stone recurrence among Indonesian kidney stone formers: a comprehensive analysis of genetic polymorphism, demographic, and clinical factors

BACKGROUND The recurrence rate of kidney stone disease (KSD) can exceed 50% within 5 years. This study aimed to investigate factors associated with stone recurrence based on single nucleotide polymorphisms (SNPs) of the calcium-sensing receptor (CaSR) rs1801725 and rs1042636, demographic, and clinical profiles. METHODS We collected data on the demographic and clinical characteristics of 80 adult kidney stone formers from April 2021 to September 2022, including peripheral blood samples, morning and 24-hour urine, and 7-day water intake records. Real-time polymerase chain reaction was used to evaluate SNP. Comparisons were made between patients with recurrent and first-time stones. RESULTS 41% of 80 patients have experienced stone recurrence. Recurrent stone formers exhibited significantly higher 24-hour urine calcium excretion (p = 0.03) and lower serum calcium levels (p = 0.019) than first-time stone formers. Hypocitraturia (100%), low urine volume (78%), and hyperoxaluria (55%) were the main abnormalities of all patients. No significant differences were found in CaSR gene polymorphisms and other demographic, biochemical, or clinical parameters. CONCLUSIONS Recurrent stone formers had higher 24-hour urine calcium excretion and lower serum calcium levels. Other risk factors and CaSR polymorphisms may insignificantly affect KSD recurrence.

Predicting urinary stone recurrence: a joint model analysis of repeated 24-hour urine collections from the MSTONE database

To address the limitations in existing urinary stone recurrence (USR) models, including failure to account for changes in 24-hour urine (24U) parameters over time and ignoring multiplicity of stone recurrences, we presented a novel statistical method to jointly model temporal trends in 24U parameters and multiple recurrent stone events. The MSTONE database spanning May 2001 to April 2015 was analyzed. A joint recurrent model was employed, combining a linear mixed-effects model for longitudinal 24U parameters and a recurrent event model with a dynamic first-order Autoregressive (AR(1)) structure. A mixture cure component was included to handle patient heterogeneity. Comparisons were made with existing methods, multivariable Cox regression and conditional Prentice-Williams-Peterson regression, both applied to established nomograms. Among 396 patients (median follow-up of 2.93 years; IQR, 1.53–4.36 years), 34.6% remained free of stone recurrence throughout the study period, 30.0% experienced a single recurrence, and 35.4% had multiple recurrences. The joint recurrent model with a mixture cure component identified significant associations between 24U parameters - including urine pH (adjusted HR = 1.991; 95% CI 1.490–2.660; p < 0.001), total volume (adjusted HR = 0.700; 95% CI 0.501–0.977; p = 0.036), potassium (adjusted HR = 0.983; 95% CI 0.974–0.991; p < 0.001), uric acid (adjusted HR = 1.528; 95% CI 1.105–2.113, p = 0.010), calcium (adjusted HR = 1.164; 95% CI 1.052–1.289; p = 0.003), and citrate (adjusted HR = 0.796; 95% CI 0.706–0.897; p < 0.001), and USR, achieving better predictive performance compared to existing methods. 24U parameters play an important role in prevention of USR, and therefore, patients with a history of stones are recommended to closely monitor for future recurrence by regularly conducting 24U tests.

Comparing the Accuracy of Standard Equations to Predict Glomerular Filtration Rate for Persons with Spinal Cord Injury: Which Is the "Best Fit?"

Patients with spinal cord injury (SCI) are at increased risk of renal insufficiency, so their renal function must regularly be monitored. Glomerular filtration rate (GFR) assessment is challenging as it requires measuring clearance of exogenous markers, which is impractical in most clinical settings. Thus, equations have been formulated to estimate GFR that utilize serum creatinine (Cr) or cystatin C (CysC). Given loss of muscle mass after SCI, we hypothesized equations using CysC would be more accurate than those using Cr after SCI. Fifty-eight persons (51 male/7 female; age 22-87 years) with SCI level C2-L1/AIS A-D were enrolled. Serum CysC and Cr, 24-hour urine creatinine (24hrUCr) and 24-hour urine urea (24hrUurea) were collected. Average of the 24hrUCr clearance and 24hrUurea clearance was calculated (AvgClCrUr). Six GFR estimating equations were compared to AvgClCrUr. For each equation, mean bias (AvgClCrUr - eGFR) was calculated followed by the Pearson correlation calculation between AvgClCrUr and eGFR. In addition, the percentage of estimated values within 15%, 30%, and 50% of AvgClCrUr values are reported for each estimating equation. 2012 CKD-EPI CysC equation (bias 9.32 mg/dL, 95% CI, -1.23 to -17.41) was the most accurate predictor of GFR. This model accurately predicted GFR of 81%, 57%, and 33% within ±50%, ±30%, and ±15% of the AvgClCrUr, respectively. Conclusion: In persons with SCI, the CKD-EPI 2012 CysC equation, which uses cystatin C rather than creatinine, is the most accurate of the six equations tested in estimating GFR in persons with SCI.

The 24-Hour Urinary Cortisol/Urinary Creatinine Ratio Helps Differentiate Cushing's Syndrome from Simple Obesity

BackgroundCushing's syndrome (CS) is a condition caused by an increase in blood cortisol levels, leading to elevated blood sugar, osteoporosis, neuropsychiatric disorders, and weight gain and abnormal fat distribution. Its diagnostic process is cumbersome, and the process of clinical confirmation is influenced by many factors. ObjectivesIn this study, we investigated the relationship between the 24-hour urinary cortisol/urinary creatinine ratio (24hUCor/Cr) and other relevant biological markers associated with CS in an attempt to find novel ways to diagnose the disease. MethodsThis cross-sectional study included 395 hospitalized patients. Urinary cortisol and creatinine were measured by retaining a 24-hour urine sample. Multivariate binary logistic regression analysis was used to test the correlation between the 24hUCor/Cr and CS. All patients diagnosed with CS underwent a standardized diagnostic process. ResultsOf the 395 subjects, 94 (23.8%) were diagnosed with CS. In the unadjusted model, the likelihood of subjects having CS increased with increasing 24hUCor/Cr (odds ratio: 2.05, 95% confidence interval: 1.56–2.71; P<0.001). In the fully adjusted model, the risk of patients developing CS increased by 74% for each standard deviation increase in the 24hUCor/Cr (95% confidence interval: 1.02–2.97; P<0.05). Based on the subject working characteristic curve analysis and Youden’s index, the sensitivity and specificity of the 24hUCor/Cr for predicting CS were 88.3% and 91.7%, respectively, in all subjects (cutoff value: 52.3554, AUC: 0.942; P<0.001) ConclusionA higher 24hUCor/Cr helped to identify CS with an optimal cutoff value of 52.3554.

Systematic review and meta-analysis of biological variation data of urine albumin, albumin to creatinine ratio and other markers in urine

IntroductionSignificant variations in Biological Variation (BV) estimates have been reported for urine markers. This study aimed to systematically review and critically appraise BV studies for albumin, creatinine, albumin-to-creatinine ratio (ACR), and other urine markers to perform a meta-analysis of eligible studies. MethodsPublications were identified through a systematic search and evaluated using the Biological Variation Data Critical Appraisal Checklist (BIVAC). BIVAC-compliant studies (grades A-C; A being fully compliant) conducted in healthy individuals were included in the meta-analysis, providing within-subject (CVI) and between-subject (CVG) BV estimates with 95% confidence intervals for various sample collection types. ResultsOut of 37 studies evaluated, 16 were included (one grade A, three B, twelve C). No eligible publications were identified for meta-analysis of albumin and ACR. Limited data were available for first-morning urine specimens. A CVI between 15% and 30% was found for most measurands in 24-hour urine samples, while CVI estimates for random urine appeared higher. ConclusionPublished BV studies on urine markers utilized different sample collections and reporting units. Most were considered unfit for use or ineligible for meta-analysis. Given the critical role of urine albumin and ACR in chronic kidney disease risk assessment, there is a need for more BIVAC-compliant studies.

Cortisol and ACTH response to Dex/CRH Testing and 24-Hour Urine Free Cortisol Levels in Women with and without Premenstrual Dysphoric Disorder

HPA axis dysregulations are consistently reported in depression and other mood disorders, whereas previous studies examining HPA axis function in women with premenstrual dysphoric disorder (PMDD) have yielded inconsistent findings. In this study, we characterized the HPA axis in women with PMDD using the combined dexamethasone suppression and CRH stimulation (Dex/CRH) test and 24-hour urine free cortisol (UFC). A total of 26 women with prospectively confirmed PMDD and 25 asymptomatic controls (ACs) underwent Dex/CRH and UFC testing during both the mid-follicular and luteal phases of the menstrual cycle (MC). Primary outcomes were serial plasma cortisol and ACTH levels, their area-under-the-curve (AUC), and 24-hour UFC levels. Serial cortisol and ACTH levels were compared using a mixed model, while UFC levels and AUC of cortisol and ACTH were compared using Wilcoxon Signed Rank test. There were no significant diagnostic or menstrual cycle phase effects on plasma cortisol or ACTH levels (from time 0 to +75minutes), nor on the AUCs of plasma cortisol or ACTH (p > 0.05 for all comparisons). The PMDD group had significantly reduced 24-hour UFC levels compared to the AC group during both follicular and luteal phases (p=0.0004 and p=0.0007, respectively). Our study suggests that the pathophysiology of PMDD is distinct from that of major depression and is associated with neither exaggerated nor enhanced HPA axis activity or reactivity. Instead, we observed reduced overall HPA axis activity, which could reflect compensatory mechanisms downregulating HPA axis activity in response to chronic stress.