Increase In Serum Creatinine Concentration Research Articles

Unique Transcriptional Programs Identify Subtypes of AKI.

Two metrics, a rise in serum creatinine concentration and a decrease in urine output, are considered tantamount to the injury of the kidney tubule and the epithelial cells thereof (AKI). Yet neither criterion emphasizes the etiology or the pathogenetic heterogeneity of acute decreases in kidney excretory function. In fact, whether decreased excretory function due to contraction of the extracellular fluid volume (vAKI) or due to intrinsic kidney injury (iAKI) actually share pathogenesis and should be aggregated in the same diagnostic group remains an open question. To examine this possibility, we created mouse models of iAKI and vAKI that induced a similar increase in serum creatinine concentration. Using laser microdissection to isolate specific domains of the kidney, followed by RNA sequencing, we found that thousands of genes responded specifically to iAKI or to vAKI, but very few responded to both stimuli. In fact, the activated gene sets comprised different, functionally unrelated signal transduction pathways and were expressed in different regions of the kidney. Moreover, we identified distinctive gene expression patterns in human urine as potential biomarkers of either iAKI or vAKI, but not both. Hence, iAKI and vAKI are biologically unrelated, suggesting that molecular analysis should clarify our current definitions of acute changes in kidney excretory function.

A Preoperative Multimarker Approach to Evaluate Acute Kidney Injury After Cardiac Surgery

To investigate whether a multimarker strategy combining preoperative biomarkers representing distinct pathophysiologic pathways enhances preoperative risk assessment of acute kidney injury after cardiac surgery (CSA-AKI) and increases knowledge of underlying pathogenesis. Prospective, cohort study. Single-center tertiary referral hospital. The study comprised 1,015 adults undergoing cardiac surgery with cardiopulmonary bypass. CSA-AKI was defined as≥50% increase in serum creatinine concentration, absolute increase≥26 µmol/L, or new requirement for dialysis. Preoperative and perioperative information until hospital discharge was recorded. Preoperative plasma levels of C-reactive protein, terminal complement complex, neopterin, lactoferrin, N-terminal pro-brain natriuretic peptide, and cystatin C were determined using enzyme immunoassays. Biomarkers were selected based on causal hypotheses of underlying mechanisms and were related to inflammatory, hemodynamic, or renal signaling pathways. One hundred patients (9.9%) developed CSA-AKI. Higher baseline plasma concentrations of neopterin and N-terminal pro-brain natriuretic peptide were associated independently with CSA-AKI (p = 0.04 and p<0.001, respectively). Lower baseline plasma lactoferrin concentrations were observed in patients with CSA-AKI (p = 0.05). Compared with clinical risk assessment, addition of these biomarkers provided a slight, but significant, increment in predictive utility (area under the curve 0.81-0.83, likelihood ratio test p<0.001). A net of 12% of patients were reclassified correctly, and improved prediction was demonstrated, especially in patients with intermediate risk (56% correct reclassification). Preoperative hemodynamic, renal, and immunologic function play central roles in the pathogenesis of CSA-AKI. These findings add evidence to the potential of a multimarker approach to improve preoperative prediction of CSA-AKI.

A low plasma 1,25(OH)2 vitamin D/PTH (1–84) ratio predicts worsening of renal function in patients with chronic heart failure

BackgroundDysregulation of the vitamin D system promotes renal dysfunction and has direct detrimental effects on the heart. Progressive deterioration of renal function is common in patients with chronic heart failure (HF) and is invariably associated with unfavorable outcomes which can be improved by early identification and timely interventions. We examined the relation between two plasma markers of vitamin D metabolism and worsening of renal function (WRF) in a large cohort of patients with chronic HF. MethodsPlasma levels of 1,25-dihydroxyvitamin D (1,25(OH)2D) and parathyroid hormone PTH (1–84) were measured in 1237 patients with clinical evidence of chronic and stable HF enrolled in the multicentre GISSI-HF trial and followed for 3.9years. We examined the relation of 1,25(OH)2D, PTH(1–84), and their ratio with WRF, defined as first increase in serum creatinine concentration ≥0.3mg/dL and ≥25% at two consecutive measurements at any time during the study. ResultsLower 1,25(OH)2D/PTH(1–84) ratio was associated with a higher baseline serum concentration of creatinine, winter season, female sex and older age; 335 patients (29.6%) experienced an episode of WRF. After adjustment, a lower 1,25(OH)2D/PTH(1–84) ratio remained significantly associated with a higher risk of WRF (HR=0.75 [0.62–0.90], p=0.002) and correctly reclassified events. This ratio also independently predicted mortality and admission to hospital for cardiovascular reasons. ConclusionsThe plasma 1,25(OH)2D/PTH(1–84) ratio is a promising indicator of future risk of deterioration of renal function in patients with chronic HF and mild renal impairment, that may serve to optimize therapies and improve outcomes.

Does Acute Kidney Injury From an Ultramarathon Increase the Risk for Greater Subsequent Injury?

Examine whether the acute kidney injury (AKI) commonly observed among ultramarathon participants places the individual at risk for subsequent AKI of worse magnitude. Observational. Western States Endurance Run. Race finishers with postrace blood studies. Acute kidney injury after 1 race. Extent of AKI in subsequent race. Among 627 finishes in which serum creatinine values were known, 36.2% met "risk" or "injury" criterion with this group characterized by having faster finish times, greater body weight loss during the race, and higher postrace serum creatine kinase and urea nitrogen concentrations when compared with those not meeting the criteria. We identified 38 runners who had undergone postrace blood analyses at multiple races among which 16 (42.1%) met the risk or injury criterion at the first race. Of those 16 runners, 12 (75%) met the criteria at a subsequent race, an incidence that was higher (P = 0.0026) than the overall 36.2% incidence. For most (56.2%) of the 16 runners meeting the criteria at the first race, the subsequent race caused less increase in serum creatinine concentration and decrement in estimated glomerular filtration rate than the first race. Mild AKI is common in 161-km ultramarathons, but there was no evidence that previous AKI caused greater renal dysfunction from a subsequent exercise stimulus of similar magnitude. This offers some reassurance to runners and their physicians that mild to moderate AKI in the setting of an ultramarathon is not cumulative or without complete recovery of kidney function when stressed.

PS 02-03 STUDY OF CONTRAST INDUCED NEPHROPATHY IN PATIENTS UNDERGOING CARDIAC CATHETERIZATION AT UPPER EGYPT

Objective: Contrast-induced nephropathy (CIN) has been the third leading cause of hospital-acquired renal failure. Patients with cardiac diseases are particularly at risk especially when repeated injections of contrast media are often required. (CIN) is generally defined as an increase in serum creatinine concentration of ≥0.5 mg/dL (≥44 μmol/L) or 25% above baseline within 48 hours after contrast administration. Our aims are to examine the frequency of (CIN) after cardiac catheterization and to to identify possible risk factors for (CIN) in these patients. Design and Method: The study included 104 patients, 64 (61.5%) are males while, 40 (38.5%) are females with a mean age 56.11. ± 10.03, attending Sohag University Hospital's Catheterization Unit for diagnostic or interventional coronary catheterization.. 44 (42.3%) patients are diabetics, 43 (41%) are hypertensive, 6 (5.7%) have CHF, 69 (66.3%) on statins, 74 (71.2 %) are on ACEIs or ARBs, 19 (15.4%) are on metformin, 6 (5.8%) are on NSAIDs, 30 (28.8%) are on diuretics. All patients were subjected to thorough history and full clinical examination. Coronary angiography was done in the standard fashion. Serum creatinine was done before and after 48hrs following procedure. Results: The overall incidence of (CIN) was 12.5%. (CIN) increased with older age, particularly above the age of 60 years. There was an increase in the incidence of (CIN) in diabetic versus non diabetic patients (20.5% and 6.7%) respectively, (p < 0.03). There was a highly significant increase in incidence of CIN in patients with CHF versus those without CHF (100% and 71%) respectively, (P < 0001). Patients on diuretics showed significant increase in the incidence of CIN representing 61.5% of all patients who developed (CIN). Conclusions: Older patients, diabetic patients, patients with CHF and patients on diuretics have higher risk of developing (CIN) during coronary catheterization and should receive reno protective measures before contrast exposure.

Incidence of acute kidney injury after elective lower limb arthroplasty

Study objectiveThe aim of this study was to establish the incidence of acute kidney injury (AKI) in patients undergoing elective hip and knee arthroplasty. DesignThis was a retrospective cohort study. SettingThe study was conducted in a district general hospital in the United Kingdom. PatientsAll patients undergoing elective hip and knee arthroplasty over a period of 6 months were included in the study. MeasurementPreoperative and postoperative serum creatinine concentration was recorded in all patients. AKI was defined according to the Acute Kidney Injury Network classification as an increase of serum creatinine concentration of >26.5 μmol/L (≥0.3 mg/dL) or increase to 1.5-fold from baseline. Main resultsThree hundred thirty-seven patients were included in the study. Forty-eight had preexisting stage 3 chronic kidney disease (CKD). The overall incidence of AKI in our study was 6.2%. The incidence in patients with preexisting stage 3 CKD (estimated glomerular filtration rate <60 mL/[min 1.73 m2]) was 16.3%, whereas in patients without preexisting stage 3 CKD, the incidence was 4.5%. ConclusionWe identified stage 3 or higher CKD as a major risk factor for developing postoperative AKI. Preexisting CKD raised the risk of developing AKI 4-fold. We recommend that all patients undergoing lower limb arthroplasty should have renal function assessed preoperatively. In the perioperative period, renal function should be monitored in all patients. This is of particular importance in patients with estimated glomerular filtration rate <60.

New insights into renal toxicity of the B-RAF inhibitor, vemurafenib, in patients with metastatic melanoma.

Vemurafenib (VMF) is a B-RAF inhibitor used in the treatment of B-RAF-V600-mutant metastatic melanomas. Reports of acute kidney injury (AKI) in patients treated with VMF are scarce. To investigate the incidence and severity of AKI, we conducted a retrospective, observational, monocentric study in the Lyon Sud Hospital University, France, which included 74 patients with metastatic B-RAF-mutated melanomas treated with VMF, between June 2011 and August 2014. According to the Kidney Disease Improving Global Outcomes Guidelines, AKI is defined as an increase in serum creatinine concentration exceeding the baseline concentration by 1.5 fold. Serum creatinine was thus determined before treatment, on a monthly basis during treatment, and 3months after treatment discontinuation. Patients were divided into two main groups: AKI-positive (AKI+) and AKI-negative (AKI-) and further subdivided into three groups according to AKI severity (stage 1, 2 or 3). To visualize the tissue damage caused by VMF, kidney biopsies were performed for two stage 1 AKI+ patients. Of the 74 patients, 30 (40.5%) were AKI-, and of the 44 AKI+ patients (59.5%), 29 (66%) were diagnosed within the first three months of treatment. There were significantly more men in the AKI+ group: n=33 (75%) versus n=12 (40%) women, p=0.004 with an odds ratio for developing AKI of 4.6 (95% CI 1.48-14.23). Most AKI+cases were considered as stage 1 (n=40; 91%) and the remaining four (9%) as stage 2 AKI. Kidney biopsies revealed interstitial fibrosis and acute focal tubular damage. However, renal failure was reversible in 80% of patients within 3months of VMF discontinuation. We observed frequent, reversible, moderately severe AKI with some histological evidence of tubular and interstitial damage in VMF-treated patients, suggesting that renal function should be carefully monitored in male patients, especially during the first 3months.

A meta-analysis of renal outcomes in living kidney donors.

Given the increased burden of end-stage renal disease (ESRD), renal outcomes of kidney donation by living donors are of particular interest. PubMed, ProQuest, MEDLINE, EMBASE, Chinese national knowledge infrastructure, and Wanfang databases were searched for clinical outcomes of living kidney donors (LKDs) including renal death, ESRD, proteinuria/albuminuria, and renal function after donation. We included 62 studies from 19 countries involving 114,783 kidney donors and nondonors to evaluate the renal consequences less than 6 months, 6 months to 5 years, 5 to 10 years, and 10 years onward after donation. The pooled data showed that uninephrectomy significantly decreased glomerular filtration rate and creatinine clearance rate in parallel with increased serum creatinine concentration (all P < 0.05). The drastic changes in renal function occurred within 6 months rather than 5 to 10 years after donation. Ten years and onward, rate of proteinuria/albuminuria increased gradually: microalbuminuria from 5.3% to 20.9%, proteinuria from 4.7% to 18.9%, and overt proteinuria from 2.4% to 5.7% (all P < 0.05). Prevalence of ESRD was 1.1%. All-cause mortality was 3.8% and all the renal deaths on average occurred 10 years postnephrectomy. LKDs might have aggravated glomerular filtration and creatinine clearance within 6 months after donation. Five years and onward, albuminuria, proteinuria, ESRD, and death might be the major concerns of LKDs. Long-term studies may clarify the survival time after donation.

Sodium Bicarbonate and Renal Function After Cardiac Surgery

BACKGROUND: The effect of urinary alkalinization in cardiac surgery patients at risk of acute kidney injury (AKI) is controversial and trial findings conflicting. Accordingly, the authors performed a prospectively planned individual patient data meta-analysis of the double-blind randomized trials in this field. METHODS: The authors studied 877 patients from three double-blind, randomized controlled trials enrolled to receive either 24 h of intravenous infusion of sodium bicarbonate or sodium chloride. The primary outcome measure was a postoperative increase in serum creatinine concentration of greater than 25% or 0.5 mg/dl (> 44 μM/L) within the first five postoperative days. Secondary outcomes included the raw change in serum creatinine, greater than 50% and greater than 100% rises in serum creatinine, developing AKI (Acute Kidney Injury Network criteria), initiation of renal replacement therapy, morbidity, and mortality. RESULTS: Patients were similar in demographics, comorbidities, and cardiac procedures. Sodium bicarbonate increased plasma bicarbonate (P < 0.001) and urine pH (P < 0.001). There were no differences in the development of the primary outcome (Bicarbonate 45% [39-51%] vs. Saline 42% [36-48%], P = 0.29). This result remained unchanged when controlling for study and covariates (odds ratio [OR], 99% confidence interval [CI]: Bicarbonate vs. Control, 1.11 [0.77-1.60], P = 0.45). There was, however, a significant study-adjusted benefit in elective coronary artery bypass surgery patients in terms of renal replacement therapy (Bicarbonate vs. Control, OR: 0.38 [99% CI: 0.25-0.58], P < 0.0001) and the development of an Acute Kidney Injury Network grade = 3 (Bicarbonate vs. Control, OR: 0.45 [99% CI: 0.43-0.48], P < 0.0001). CONCLUSIONS: Urinary alkalinization using sodium bicarbonate infusion is not associated with an overall lower incidence of AKI; however, it reduces severe AKI and need for renal replacement therapy in elective coronary artery bypass patients.

Urinary Neutrophil Gelatinase-associated Lipocalin as a Marker for Identification of Acute Kidney Injury and Recovery in Dogs with Gentamicin-induced Nephrotoxicity.

BackgroundAcute kidney injury (AKI) is associated with high mortality rates in dogs, which may be a consequence of late recognition using traditional diagnostic tests. Neutrophil gelatinase‐associated lipocalin (NGAL) is a protein‐induced during kidney injury that may identify AKI earlier than traditional tests.Objectives/HypothesisTo evaluate urinary NGAL (uNGAL) and uNGAL‐to‐urinary creatinine ratio (UNCR) as early markers of kidney injury and recovery in an AKI model in dogs. It was hypothesized that these markers would document AKI earlier than serum creatinine concentration.AnimalsFive purpose‐bred dogs.MethodsProspective study. Acute kidney injury, defined as a > 50% increase in serum creatinine concentration above baseline, was induced in dogs by gentamicin administration (8–10 mg/kg SC q8h). Blood and urine collected for biochemical analyses and uNGAL and urinary creatinine concentrations, respectively, during AKI induction and recovery.ResultsAcute kidney injury was diagnosed significantly earlier based on a 7‐fold increase in UNCR compared to a > 50% increase in serum creatinine concentration (day 8; range, 2–10 mg/dl vs day 16; range, 14–19 mg/dl; P = .009). During recovery, the initial decrease in UNCR preceded the decrease in serum creatinine concentration by a median of 2 days. The uNGAL changes paralleled UNCR changes, but the increase in uNGAL was triphasic; the initial peak occurred earlier than UNCR (median, day 11 versus median, day 19).Conclusions and Clinical ImportanceThe UNCR was early marker of gentamicin‐induced AKI and its decrease documented onset of renal recovery. Additional studies are needed to validate this marker in dogs with naturally occurring renal injury.

Primer Perkütan Koroner Girişim Uygulanan Hastalarda Serum Prokalsitonin Düzeyi ile Kontrast Nefropatisi Arasındaki İlişki

Objective:We aimed to investigate the relationship between serum procalcitonin level and contrast-induced nephropathy (CIN) in patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI). Material and Methods: Three hundred forty-one consecutive STEMI patients (mean age: 57±11 years; 67.1% male) who underwent PPCI in our clinic between April 2013 and December 2013 were studied. CIN was defined as an increase in serum creatinine concentration ≥ 25% over baseline. Biochemical tests, including determination of serum procalcitonin level, were performed before (baseline) and 48 h after PPCI. Results: Of 341 study patients, 96 (28.2%) developed CIN. The median (interquartile range) baseline procalcitonin level was significantly higher in the CIN (+) group [0.075 μg/L (0.70-1.20 μg/L) versus 0.05 μg/L (0.75-1.00 μg/L), p<0.001)]; however, high procalcitonin was not an independent predictor of CIN in multivariate logistic regression analysis (p=0.274). On the other hand, high serum C-reactive protein level (odds ratio: 1.02 [1.01-1.04], p=0.002), high amount of contrast media used (odds ratio 1.12 [1.08-1.17], p<0.001), and low rate of post-procedural thrombolysis in myocardial infarction (TIMI) grade 3 flow (odds ratio 0.05 [0.01-0.49], p=0.01) were identified as independent predictors of CIN. Conclusion: Serum procalcitonin level does not have a clear association with CIN; however, underlying reasons for the higher serum procalcitonin levels in patients who developed CIN need to be explored with further studies.

Risk Factors Associated with Cisplatin-Induced Nephrotoxicity in Patients with Advanced Lung Cancer.

Cisplatin (CDDP) combination chemotherapy is widely administered to patients with advanced lung cancer. The dose depends on multiple factors, including whether the tumor is non-small-cell lung cancer (NSCLC) or small-cell lung cancer (SCLC). Although efficacy is limited by cisplatin-induced nephrotoxicity (CIN), little is known about the risk factors for this complication. The aim of this study was to identify the risk factors for CIN in patients with advanced lung cancer, both NSCLC and SCLC. We retrospectively reviewed clinical data for 148 patients who underwent initial chemotherapy including CDDP ≥50 mg/m2 per patient per day for the first course at Kyushu Medical Center between October 2010 and September 2013. All data were collected from the electronic medical record system. Nephrotoxicity was defined as an increase in serum creatinine concentration of at least grade 2 during the first course of CDDP chemotherapy, as described by the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. CIN was observed in nine patients. Univariate analysis revealed that cardiac disease and lower baseline serum albumin (Alb) values conferred a higher risk of nephrotoxicity (p<0.05). The cut-off value of Alb was 3.8 g/dL, calculated by receiver operating characteristics (ROC) curves. Multivariable logistic regression analysis revealed that cardiac disease (odds ratio=11.7; p=0.002) and hypoalbuminemia (odds ratio=6.99 p=0.025 significantly correlated with nephrotoxicity. In conclusion, cardiac disease and low baseline Alb values are possible risk factors for CIN.

Combined Effects of Cd and Hg on Liver and Kidney Histology and Function in Wistar Rats

The present study was performed in order to discern the effects of combined exposure to cadmium and mercury on liver function and histopathological alterations in male adult Wistar rats. In the present investigation, cadmium (100 mg/l) and mercury (25 mg/l) were administered orally for 10 weeks separately or in combination. The rational for studying cadmium and mercury is that both of these metals are encountered frequently in the same contaminated areas. In liver, the activities of serum alanine aminotransferase (ALT) and aspartate amino tranferase (AST) increased significantly in the cadmium (Cd) and mercury (Hg) alone or in combination (Cd + Hg) compared to the control suggesting that both cadmium and mercury cause hepatotoxicity spatially when co-administrated. We noted an increase in serum lactate dehydrogenase (LDH) activity in Cd and combined Cd + Hg treated groups while it decreased in Hg treated group. There was no statistically significant change in the level of total bilirubilin. Serum urea concentration showed a significant increase in the Cd and Hg groups compared to the control group. However an increase in serum creatinine concentration was noted only in the combined treated rats showing that renal insufficiency is more serious in the co-exposed group. Light microscopic examination indicated severe histological changes in the two organs under Cd and mercury influence. Results of the present investigation clearly showed that mercury has profound effects of hepatic handling of cadmium (synergistic effect) as shown by histological and biochemical results. Moreover, we observed a antagonist effect between these two toxic metals on kidney markers such as urea.

Peri-operative renal dysfunction: prevention and management.

Postoperative increases in serum creatinine concentration, by amounts historically viewed as trivial, are associated with increased morbidity and mortality. Acute kidney injury is common, affecting one in five patients admitted with acute medical disease and up to four in five patients admitted to intensive care, of whom one in two have had operations. This review is focused principally on the identification of patients at risk of acute kidney injury and the prevention of injury. In the main, there are no interventions that directly treat the damaged kidney. The management of acute kidney injury is based on correction of dehydration, hypotension, and urinary tract obstruction, stopping nephrotoxic drugs, giving antibiotics for bacterial infection, and commencing renal replacement therapy if necessary.

Contrast Induced Nephropathy and Long-term Renal Decline After Percutaneous Transluminal Angioplasty for Symptomatic Peripheral Arterial Disease

Administration of iodinated contrast media during endovascular procedures for peripheral arterial disease (PAD) may cause contrast induced nephropathy (CIN). The aim of the present study was to establish the incidence of CIN after these procedures and to study its association with long-term loss of kidney function, cardiovascular events, and death. Consecutive patients first presenting with symptomatic PAD (Rutherford classification II-VI) who were treated with an endovascular procedure were included in this prospective observational cohort study. CIN was defined as >25% increase of serum creatinine concentration from baseline at 5 days after the intervention. Some 337 patients were included with a mean estimated glomerular filtration rate (eGFR) of 67 mL/minute. Thirteen percent (95% confidence interval [CI] 9-16) of these patients developed CIN after endovascular interventions for PAD. One year after treatment, eGFR was reduced by 12.4 mL/minute (95% CI 8.6-16.2) in patients with CIN compared with 6.2 mL/minute (95% CI 4.9-7.0) in patients without acute kidney injury (p < .01). After correction for potential confounders, CIN was associated with a 7.8 mL/minute (95% CI 4.5-11.0) reduction of eGFR at 1 year after endovascular intervention (p < .01). Furthermore, patients with CIN were at increased risk of long-term cardiovascular events and mortality. Exposure to iodinated contrast media during endovascular procedures for symptomatic PAD frequently results in CIN. Patients with CIN are at increased risk of long-term loss of renal function, cardiovascular events, and death.

Neutrophil Gelatinase‐Associated Lipocalin in Dogs With Sepsis Undergoing Emergency Laparotomy: A Prospective Case–Control Study

BackgroundNeutrophil gelatinase‐associated lipocalin (NGAL) is an early indicator of acute kidney injury (AKI) in dogs and its use has not been evaluated in dogs with sepsis.AnimalsFifteen dogs with sepsis requiring laparotomy (study dogs) and 10 dogs undergoing surgery for intervertebral disc disease (control dogs).ObjectiveTo determine whether NGAL increases in dogs with sepsis undergoing emergency laparotomy and whether it is correlated with development of AKI and survival.MethodsLongitudinal study conducted at a referral teaching hospital. Serum neutrophil gelatinase‐associated lipocalin (sNGAL), urinary NGAL normalized to urinary creatinine concentration (UNCR), and serum creatinine concentration were measured at 4 time points (admission, after anesthesia, and 24 and 48 hours postsurgery). Development of AKI (increase in serum creatinine concentration of 0.3 mg/dL) and in‐hospital mortality were recorded. Linear mixed‐model analysis was employed to assess differences between groups over time. Mann–Whitney U‐test was performed for comparison of continuous variables between groups and Chi square or Fisher's exact tests were used to assess correlation between discrete data.ResultsSerum NGAL and UNCR were significantly higher in study dogs across all time points (P = .007 and P < .001, respectively) compared with controls. Urinary NGAL normalized to creatinine in the study group was not significantly different between survivors (n = 12) and nonsurvivors (n = 3). Dogs that received hydroxyethyl starch had significantly higher UNCR across all time points (P = .04) than those that did not.Discussion—ConclusionSerum neutrophil gelatinase‐associated lipocalin and UNCR are increased in dogs with sepsis requiring emergency laparotomy. Additional studies are needed to evaluate its role as a marker of AKI in this population.

Right ventricular systolic dysfunction and vena cava dilatation precede alteration of renal function in adult patients undergoing cardiac surgery: An observational study.

Several authors have suggested that right ventricular dysfunction (RVd) may contribute to renal dysfunction in nonsurgical patients. We tested the hypothesis that RVd diagnosed immediately after cardiac surgery may be associated with subsequent development of renal dysfunction and tried to identify the possible mechanisms. A single-centre, prospective observational study. Amiens University Hospital, France. All adult patients undergoing cardiac surgery were considered eligible for participation. Patients who had undergone pulmonary or tricuspid valve surgery, repeat surgery or who underwent immediate postoperative renal replacement therapy were excluded. Data from 74 patients were analysed. Left ventricular and right ventricular function were assessed before surgery and on admission to ICU by transthoracic echocardiography (TTE): left ventricular and right ventricular ejection fractions (LVEF/RVEF), tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (Sr(t)) and right ventricular dilatation. RVd was defined as values in the lowest quartile of at least two echocardiographic variables. Renal dysfunction was defined as an increase in serum creatinine concentration (sCr) on postoperative day 1. All right ventricular TTE variables decreased (P < 0.05) after surgery: RVEF from 50% (49 to 60) to 40% (35 to 50); TAPSE from 22.3 mm (19.4 to 25.3) to 12.2 mm (8.8 to 14.8); and Sr(t) from 15.0 cm s(-1) (12.0 to 18.0) to 8.1 cm s(-1) (6.3 to 9.2). Fourteen (19%) patients had right ventricular dilatation and RVd was present in 23 (31%) patients. Forty patients had a positive variation in sCr. In multivariate analysis, patients with RVd had an odds ratio (OR) of 12.7 [95% confidence interval (95% CI) 2.6 to 63.4, P = 0.02] for development of renal dysfunction. Renal dysfunction was associated with increased central venous pressure but was not associated with cardiac index (CI). These results suggest that early postoperative RVd is associated with a subsequent increase of sCr and that the mechanism involved is congestion (vena cava dilatation/elevated CVP) rather than decreased CI.

PP.17.18

Objective: Evaluate circadian blood pressure (BP) variation in hypertensive patients and analyze it's association with kidney function. Design and method: Retrospective analysis of 24-h BP monitoring results in 63 hypertensive patients and their clinical, laboratory data was performed. According to nocturnal fall (NF) of BP patients were categorized into following groups. Group A were dippers (NF 10–20%), group B were non-dippers (NF 0–10%), group C were risers (NF < 0%) and group D were extreme dippers (NF > 20%). The relation between circadian BP and renal function was compared with dipping pattern of the patients. Statistical analysis was performed using SPSS 22.0 program. P < 0,05 was considered statistically significant. Results: Results: The 24-h BP monitoring was performed in 63 patients, 26 (41,26%) of them were males, 37 (58,73%) were females. Their mean age was 53,1 ± 18,14 years. Group A consisted of 18 (28,57%) patients, group B of 35 (55,56%) patients, group C of 8 (12,70%) patients and group D of 2 (3,17%) patients. Group D was excluded from further analysis due to low numbers. Mean nocturnal systolic/diastolic BP was 125 ± 19,24/72,61 ± 9,17 mmHg in group A, 135,71 ± 23,22/79,02 ± 14,79 mmHg in group B and 144,25 ± 30,98/77,38 ± 15,7 mmHg in group C, respectively. The differences between the groups in patients mean age and gender were not statistically significant (p = 0,261 and p = 0,286, respectively). We found a statistically significant negative correlation between mean nocturnal systolic BP and glomerular filtration rate (GFR) (r = -0,32; p = 0,011) and positive correlation between mean nocturnal systolic BP and serum creatinine concentration (r = 0,263; p = 0,038). There were no significant differences between groups regarding other values studied, such as cholesterol levels and poteinuria. Conclusions: Abnormal circadian BP pattern was found in more than 70% of patients. We found a statistically significant correlation between circadian BP variation and kidney function: increased nocturnal systolic BP correlated with decreased GFR and increased serum creatinine concentration.

Lipids, blood pressure and early cardiovascular disease, need for revisit

Aim of study was to evaluate the awareness of hypertensive patients on the presence of target organ damage. Data were collected in 1.320 hypertensive subjects (mean age 61 24 years, 611 female) consecutively referred to our Hypertension Center between November 2012 and January 2014. In this analysis we considered: creatinine serum concentration, microalbuminuria, left ventricular hypertrophy (LVH), carotid intima-media thickening (IMT) or plaques. Self-explaining questionnaires were administered to all patients in order to investigate whether they were aware of having any alterations in such variables. The questionnaire, which included quantitative and qualitative variables, was guided by a nurse or a physician. Patients were asked: Whether they knew the value of creatinine and microalbuminuria and if these were normal or pathological. If they made an EKG or echocardiography and these revealed LVH. Whether they underwent a carotid Doppler ultrasound and if it showed any alterations due to hypertension. Data obtained through the questionnaires were compared with the measurement of the same variables, obtained from the hospital data base or patients’ record-files. Results: Renal Function: increase in serum creatinine concentration (>1.2 mg/dL) was detected in the 27% of patients but 14% of them were aware of having impaired renal function. Microlabuminuria (>30 mg/g of creatinine) was found in 13% of the hypertensive patients considered, but only 4% of them knew this alteration. Left Ventricular Hypertrophy (LHV) was defined as LV mass index > 95 g/m for women and >115 g/ m for men. LVH was found in 39% of the hypertensive individuals but only 14% were aware. Carotid vascular hypertrophy and atherosclerosis was defined as IMT > 0.9mm and/or the presence of plaques. These alterations were found in 45% of the patients but only a minority of them (14%) was aware. In conclusion, our survey indicates that, in a selected population of 1320 mild-to-severe hypertensive patients referred to a specialized hypertension clinic, the awareness of asymptomatic organ damage is still low. Many patients, despite the thorough instrumental investigations performed in a specialized setting, seems not sufficiently informed on the normalcy threshold and/or tend to underestimate pathological findings.

Evaluation of thyroid-stimulating hormone, total thyroxine, and free thyroxine concentrations in hyperthyroid cats receiving methimazole treatment.

BackgroundIatrogenic hypothyroidism (IH) after treatment of hyperthyroidism can impair renal function. No study compared the efficacy of measurement of serum free thyroxine by equilibrium dialysis (fT4ed) or thyroid‐stimulating hormone (TSH) concentrations for monitoring cats receiving methimazole.ObjectivesTo (1) compare the ability of total T4 and fT4ed concentrations in conjunction with TSH to define thyroid function in hyperthyroid cats receiving methimazole, (2) determine the prevalence of IH in cats receiving methimazole, and (3) examine the relationship between thyroid axis hormones and serum creatinine concentration.AnimalsOne hundred and twenty‐five serum samples from hyperthyroid cats receiving methimazole and total T4 concentrations ≤3.9 μg/dL.MethodsTotal T4, fT4ed, and TSH concentrations were measured to evaluate thyroid status and serum creatinine concentration was measured to assess renal function. A low total T4 or fT4ed concentration in combination with an increased TSH concentration defined IH.ResultsForty‐one cats (33%) had increased TSH concentrations. Of cats with total T4 and fT4ed concentrations below the reference range, 68% and 73%, respectively, had TSH concentrations above the reference range. Only 18% of cats with a normal TSH concentration had an increased serum creatinine concentrations as compared to 39% of those with increased TSH concentrations (P < .001).ConclusionsFree T4ed does not identify more cats with potential IH as compared to total T4. The IH prevalence was approximately 20%. Measurement of TSH may be more helpful in indicating that azotemia, if present, is at least in part related to IH. Investigation is needed to define TSH assay utility in identifying possible subclinical IH.