Abnormal Kidney Function Research Articles

Chronic kidney disease and risk factors among Type 2 Diabetic patients in selected hospitals in Dhaka, Bangladesh

Chronic kidney disease (CKD) may be defined as abnormalities of kidney function or structure present for more than 3 months. Around 10% of people worldwide have CKD. The data about chronic kidney disease among diabetics in Bangladesh is inadequate, and very few studies have been done on specific populations, i.e., male or female. Thus, the study aims to determine the prevalence of CKD and its risk factors among diabetic patients in selected hospitals in Dhaka city. The specific objectives of the study were to assess the participants through physical and laboratory evaluations, categorize them into the different stages of CKD, analyze their socio-demographic characteristics, and determine the association between CKD and various risk factors. This is a cross-sectional study. The study population consisted of different outpatient diagnostic centers and outpatient and indoor patients of Shaheed Suhrawardy Medical College and Hospital. The sample size of the study is 369. The Modification of Diet in Renal Disease equation was used to calculate eGFR. This study revealed that in Dhaka, 18.2% of Type 2 Diabetic patients had CKD. Most of the participants were between 46 and 65years old. Most of the CKD patients had a low education level and a lower family income. Having diabetes for more than 3 years and hypertension for more than 5 years were associated with a higher risk of developing CKD, especially among individuals who consumed added salt in their diet.

Clinical Characteristics, Nutritional Status, and Disease Severity in Pediatric Patients with COVID-19

Background: Limited clinical data are available regarding the impact of coronavirus disease 2019 (COVID-19) on children. Objective: This study assessed the clinical characteristics, nutritional status, and disease severity in pediatric patients with COVID-19. Methods: A retrospective study examined medical records of children with COVID-19 admitted to Abuzar Hospital (Ahvaz, Iran) for six months. Data related to their clinical, nutritional status and demographic characteristics were documented. Results: This study included medical records of 500 patients. More than half of them were boys. Different levels of COVID-19 severity were observed in 202, 172, and 126 children as mild, moderate, and severe cases, respectively. Children with severe or moderate COVID-19 had substantially elevated levels of various inflammatory markers, blood urea nitrogen (BUN), gamma-glutamyl transferase (GGT), neutrophils, alanine transaminase (ALT), creatinine, bilirubin, and aspartate aminotransferase (AST) compared to those with mild COVID-19 (p < 0.001). They had lower levels of lymphocytes and vitamin D, as well as longer hospital stays than children with mild COVID-19 (p < 0.001). In addition, 52% and 40.2% of patients had malnutrition and anemia, respectively. The majority of underweight and stunted children had moderate or severe COVID-19. Conclusion: This study revealed a high prevalence of malnutrition, anemia, insufficient levels of vitamin D, elevated levels of inflammatory markers, and abnormal liver and kidney function tests in children with severe or moderate cases of COVID-19 compared to those with mild COVID-19.

Evaluation of abnormalities in kidney function in Italian and Canadian patients with severe hypertriglyceridemia and chylomicronemia

Evaluation of abnormalities in kidney function in Italian and Canadian patients with severe hypertriglyceridemia and chylomicronemia

Acknowledging acute kidney disease following ureteroscopy and laser lithotripsy: results from a tertiary care referral center.

Acute kidney disease (AKD) is a recently described syndrome consisting of kidney function abnormalities lasting less than 3 months. Little is known regarding AKD following ureteroscopy (URS) and laser lithotripsy. To evaluate the occurrence and evolution of AKD in stone patients treated with URS. Data from 284 patients treated with URS for urinary stones were retrospectively analyzed. According to the KDIGO 2020 criteria, AKD was defined as postoperative acute kidney injury (AKI) occurrence, estimated glomerular filtration rate (eGFR) decrease ≥ 35%, or serum creatinine (SCr) increase ≥ 50%. AKI was defined as SCr increase ≥ 0.3 mg/dL or ≥ 50%. AKD evolution was evaluated 60 days post-URS. Data were analyzed using descriptive statistics. Univariable (UVA) and multivariable (MVA) logistic regression analyses tested the association of patients' characteristics and perioperative data with the occurrence of AKD. Overall, postoperative AKD occurred in 32 (11.3%) patients. Recovery from AKD was found in 26 (82%) patients and persistent AKD occurred in 6 (18%) patients. At UVA, age at surgery (p = 0.05), baseline SCr (p = 0.02), baseline CKD category (p = 0.006), Charlson comorbidity index (p = 0.01), operative time (p = 0.04) and postoperative complications (< 0.001) were associated with AKD. At MVA, CKD category (OR 2.99, 95% CI = 1.4-6.3; p = 0.004), operative time (OR 1.01, 95% CI = 1.001-1.018; p = 0.023) and postoperative complications (OR 3.5, 95% CI = 1.46-8.49; p = 0.005) were independent predictors of AKD. AKD is a frequent complication in patients treated with URS. Moreover, AKD persists in a non-neglectable percentage of patients at medium-term follow-up. Therefore, nephrological assessment should be considered, especially in high-risk patients. Current findings should be considered for the peri-operative management of stone patients.

Evaluation of Serum Electrolyte Abnormalities and Kidney Function to Assess Risk of Kidney Disease in Hypertensive Patients at Kenyatta National Hospital

HTN is a known leading cause of kidney disease with over 20% of the population aged 20 years or older with HTN developing CKD. Complications from HTN and kidney disease contribute significantly to global mortality. In Kenya, data from WHO shows that about 4 million individuals suffer from CKD, with many progressing to kidney failure. The aim was to assess serum electrolyte abnormalities and kidney function among hypertensive patients at KNH. The study utilized cross-sectional retrospective data from KNH patient records. The CKD-EPI equation was used to calculate eGFR. Fisher et al.’s equation determined sample size. Data were stratified by variables such as DBP, age, sex, SBP, proteinuria, serum creatinine, urea levels, serum electrolytes, and eGFR. Data collection involved 189 patients: 82 males (43.4%) and 107 females (56.6%), with a median age of 54.00 years. 93 patients (49.20%) were &lt;54 years and 96 (50.80%) were ≥54 years. 78.84% of HTN patients had abnormal serum creatinine levels, and 54.5% had abnormal serum urea levels. 58.7% showed proteinuria. Elevated sodium levels (&gt;145 mmol/l) affected 39.68% of patients, while reduced potassium levels (&lt;3.5 mmol/l) were found in 15.34%. 41.27% had elevated chloride levels above 106 mmol/l. CKD stages varied: 3.2% had G1, 17.5% had G2, 14.8% had G3a, 29.1% had G3b, 16.4% had G4, and 19.0% had G5. Reduced renal function, estimated using GFR, was prevalent among hypertensive patients (79.4%) (95% CI:72.9-82.9), notably those ≥54 years. In conclusion, the risk of progressive kidney disease was high amongst hypertensive patients and this was evident from the proportion of patients who have abnormal kidney function including proteinuria. Early screening and implementation of therapeutic strategies can improve patient’s quality of life.

Hemolysis attributed to high dose vitamin C: Two case reports

BACKGROUND High-dose vitamin C treatment (HVCT) can reduce the adverse effect of chemotherapy and enhance the effect of antitumor therapy, which has been considered one of the safest alternative treatments. However, the severity of its adverse effects may have been underestimated. The most serious adverse effect is hemolysis, which may result in acute kidney injury or death. Although glucose-6-phosphate dehydrogenase (G6PD) deficiency is considered to be the main cause, the probability and pathological mechanism are not completely understood, leading to a lack of effective and standardized treatment methods. CASE SUMMARY Two patients with colorectal cancer developed hemolytic anemia after using 1 g/kg HVCT. In contrast to previous cases, the lowest hemoglobin level in the two cases was &lt; 50 g/L, which was lower than previously reported. This may be because Case 1 had chronic hepatitis B for many years, which caused abnormal liver reserve function, and Case 2 had grade II bone marrow suppression. Both patients improved and were discharged after blood replacement therapy. Our cases had the most severe degree of hemolysis but the best prognosis, suggesting that our treatment may be helpful for rescue of drug-induced hemolysis. This is the first review of the literature on hemolysis caused by HVCT, and we found that all patients with G6PD deficiency developed hemolysis after HVCT. CONCLUSION G6PD deficiency should be considered as a contraindication to HVCT, and it is not recommended for patients with bone marrow suppression, moderate-to-severe anemia, hematopoietic abnormalities, or abnormal liver and kidney function. Early blood purification and steroid therapy may avoid acute kidney injury or death caused by HVCT-related hemolytic anemia.

Overall Summery of Gulf Country Employees from Bangladesh, Preliminary Evaluation for Abnormal Kidney Liver and Virally Infected Individuals Using Low-cost Tests Like CBC Parameters

Hepatitis B Viruses antigen (HBsAg), Hepatitis C Virus (HCV), Human Immunodeficiency Virus (HIV) and Syphilis is a major public concern because of shared route of transmission. Alanine transaminase (ALT) and Aspartate Aminotransferase (AST) and Bilirubin is measured for abnormal liver function test and Abnormal Kidney function is measured by creatinine. The complete blood count (CBC) is the most common examination used to monitor overall health in clinical practice as well as cheap in Bangladesh. Radiological Image could have cheap but HBsAg, HCV, HIV and Syphilis test is cost effective. The main aim to this study is to determine the viral positive, abnormal Kidney, Liver function patient’s detection by doing cheap CBC test parameters. In this study, we have calculated normal patients CBC parameter and same HBsAg, HCV and syphilis patients, abnormal kidney and liver functions patients CBC parameters have been assembled. We also find out the relation with radiological image of chest X-ray for viral positive patients. The result of the study indicated that all CBC parameter of positive HBsAg, HCV and syphilis, abnormal kidney and liver patients approximately same. But only Mean Platelet Volume (MPV) and Platelet number have significant value. Abnormal Kidney and liver patients have high MPV 11.94x10^3 and HCV, HBsAg positive patients 9.9x10^3 whereas normal patients value is 9.7x10^3. This study proves that there is significant effect for MPV value with normal and viral infected patients. This finding could have used early detection for overseas health checkup.

Identification and outcomes of KDIGO-defined chronic kidney disease in 1.4 million U.S. Veterans with heart failure.

According to the Kidney Disease: Improving Global Outcomes (KDIGO) guideline, the definition of chronic kidney disease (CKD) requires the presence of abnormal kidney structure or function for >3 months with implications for health. CKD in patients with heart failure (HF) has not been defined using this definition, and less is known about the true health implications of CKD in these patients. The objective of the current study was to identify patients with HF who met KDIGO criteria for CKD and examine their outcomes. Of the 1 419 729 Veterans with HF not receiving kidney replacement therapy, 828 744 had data on ≥2 ambulatory serum creatinine >90 days apart. CKD was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (n = 185 821) or urinary albumin-to-creatinine ratio (uACR) >30 mg/g (n = 32 730) present twice >3 months apart. Normal kidney function (NKF) was defined as eGFR ≥60 ml/min/1.73 m2, present for >3 months, without any uACR >30 mg/g (n = 365 963). Patients with eGFR <60 ml/min/1.73 m2 were categorized into four stages: 45-59 (n = 72 606), 30-44 (n = 74 812), 15-29 (n = 32 077), and <15 (n = 6326) ml/min/1.73 m2. Five-year all-cause mortality occurred in 40.4%, 57.8%, 65.6%, 73.3%, 69.7%, and 47.5% of patients with NKF, four eGFR stages, and uACR >30mg/g (albuminuria), respectively. Compared with NKF, hazard ratios (HR) (95% confidence intervals [CI]) for all-cause mortality associated with the four eGFR stages and albuminuria were 1.63 (1.62-1.65), 2.00 (1.98-2.02), 2.49 (2.45-2.52), 2.28 (2.21-2.35), and 1.22 (1.20-1.24), respectively. Respective age-adjusted HRs (95% CIs) were 1.13 (1.12-1.14), 1.36 (1.34-1.37), 1.87 (1.84-1.89), 2.24 (2.18-2.31) and 1.19 (1.17-1.21), and multivariable-adjusted HRs (95% CIs) were 1.11 (1.10-1.12), 1.24 (1.22-1.25), 1.46 (1.43-1.48), 1.42 (1.38-1.47), and 1.13 (1.11-1.16). Similar patterns were observed for associations with hospitalizations. Data needed to define CKD using KDIGO criteria were available in six out of ten patients, and CKD could be defined in seven out of ten patients with data. HF patients with KDIGO-defined CKD had higher risks for poor outcomes, most of which was not explained by abnormal kidney structure or function. Future studies need to examine whether CKD defined using a single eGFR is characteristically and prognostically different from CKD defined using KDIGO criteria.

Acute Kidney Injury in Pregnancy: A Prospective Study.

When acute kidney damage occurs during pregnancy, it poses a difficult clinical problem. One of the main causes of maternal and fetal morbidity and death is pregnancy-related acute kidney injury (AKI), a significant obstetric complication characterized by a fast deterioration in renal function and several subsequent clinical problems. The objective of the study is to analyze the etiological factors, clinical manifestations, and maternal and fetal outcomes of AKI during pregnancy. This prospective observational research involved patients hospitalized in the General Medicine and Obstetrics and Gynecology departments at Indira Gandhi Institute of Medical Sciences, Patna, for a year (October 2021 to September 2022) due to obstetric difficulties resulting in acute renal damage. The study included 62 patients with a mean age of 25.08±4.25 years. The majority of patients in our study were aged 18-25 years (38, 61.3%), followed by 26-30 years (19, 30.6%) and >30 years (5, 8.1%). The majority of patients in our study were non-booked (52, 83.9%) and presented as emergency cases, whereas 10 (16.1%) patients had booked. In addition, 34 (54.8%) patients were primigravida, while 28 (45.1%) were multigravida. There were 25 patients in their third trimester (40.3%), 19 who were postpartum (30.6%), 10 who were post-abortion (16.1%), and eight in their second trimester (12.9%). Upon admission, the majority of the patients showed signs of oliguria, accounting for 45 cases (72.6%). This was followed by nine cases of abnormal kidney function (14.5%) and eight cases of anuria (12.9%). Among the other symptoms, fever was observed in 25 cases (40.32%), whereas breathlessness increased to 15 cases (24.19%), edema was present in 14 cases (22.58%), vomiting and altered sensorium were observed in four cases (6.45%), abdominal pain was observed in three cases (4.83%), and burning micturition was observed in two cases (3.22%). The most common causes of AKI in pregnancy in the present study were puerperal sepsis (18 cases, 29.0%), followed by preeclampsia/eclampsia (14 cases, 22.6%), hemorrhagic shock (10 cases, 16.1%), septic abortion (six cases, 9.7%), hyperemesis gravidarum (four cases, 6.5%), acute fatty liver of pregnancy (three cases, 4.8%), disseminated intravascular coagulation (three cases, 4.8%), drug-induced sepsis (two cases, 3.2%), and urosepsis (two cases, 3.2%). Modes of delivery in this study were normal vaginal delivery (32 cases, 51.6%), lower segment cesarean section (21 cases, 33.9%), dilation and evacuation (seven cases, 11.3%), and total hysterectomy (two cases, 3.2%). Hemodialysis was performed in 39 patients (62.9%), and 51 (82.3%) received blood transfusions. The mean systolic and diastolic BP (mmHg) were 111.37±22.60 and 71.40±18.88, respectively. Maternal outcome data revealed that 48 (77.4%) women had fully recovered, eight (12.9%) had not recovered, 43 (69.4%) were lost to follow-up, and two (3.2%) had died. Neonatal outcomes in the present study were as follows: live birth, 43 (69.4%); abortion, eight (12.9%); intrauterine death of the fetus, five (8.1%); and neonatal mortality, six (9.7%). The diagnosis and treatment of AKI during pregnancy is a significant challenge for the treating physician because of the pathophysiological changes that occur during pregnancy, the variability of symptoms, and the fact that clinical and laboratory features may occasionally overlap.

Improving Kidney Disease Care: One Giant Leap for Nephrology.

Nephrology is an ever-evolving field of medicine. The importance of such a discipline is related to the high clinical impact of kidney disease. In fact, abnormalities of kidney function and/or structure are common in the general population, reaching an overall prevalence of about 10%. More importantly, the onset of kidney damage is related to a strikingly high risk of cardiovascular events, mortality, and progression to kidney failure which, in turn, compromises quality and duration of life. Attempts to comprehend the pathogenesis and molecular mechanisms involved in kidney disease occurrence have prompted the development and implementation of novel drugs in clinical practice with the aim of treating the 'specific cause' of kidney disease (including chronic kidney disease, glomerular disease, and genetic kidney disorders) and the main immunological complications following kidney transplantation. Herein, we provide an overview of the principal emerging drug classes with proved efficacy in the context of the aforementioned clinical conditions. This can represent a simplified guide for clinical nephrologists to remind them of the vast and heterogeneous armamentarium of drugs that should be used in the present and the future to improve the management of patients suffering from kidney disease.

Vesicoureteral Reflux Fixed; Kidneys Not Fixed! – A Case Series

ABSTRACT Surgery is advocated in high-grade vesicoureteral reflux (VUR) in children (grades 4 and 5) to prevent recurrent urinary tract infections (UTIs) and prevent kidney damage. Recent studies have shown that the risk of recurrent UTIs is minimal, even with conservative management. In the three cases presented here, reimplantation of the ureters was done to abolish high-grade VUR. Yet these children have abnormal kidney function and proteinuria on long-term follow-up (10 years and more), though kidney function was normal at the time of surgery. The surgical procedures to correct the high-grade VUR do not preclude the kidney damage entirely. These children often are born with dysplastic kidneys. The outcome in terms of kidney function depends on many factors, such as the degree of dysplasia that is present in the kidneys at birth, proteinuria, hypertension, bladder-bowel dysfunction, and recurrent UTI. Abolishing VUR by surgical means does not seem to change the outcome.

Effect of Recombinant Human Thrombopoietin on Platelet Reconstitution after Autologous Peripheral Blood Stem Cell Transplantation in Patients with Multiple Myeloma

To analyze the effect of recombinant human thrombopoietin (rhTPO) on platelet (PLT) reconstitution after autologous peripheral blood stem cell transplantation (APBSCT) in patients with multiple myeloma (MM). The clinical data of 147 MM patients who were diagnosed in the First Affiliated Hospital of Soochow University and received APBSCT as the first-line therapy were retrospectively analyzed. According to whether rhTPO was used during APBSCT, the patients were divided into rhTPO group (80 cases) and control group (67 cases). The time of PLT engraftment, blood product infusion requirements, the proportion of patients with PLT recovery to≥50×109/L and≥100×109/L at +14 days and +100 days after transplantation, and adverse reactions including the incidence of bleeding were compared between the two groups. There were no significant differences between the two groups in sex, age, M protein type, PLT count at the initial diagnosis, median duration of induction therapy before APBSCT, and number of CD34+ cells reinfused (all P >0.05). The median time of PLT engraftment in the rhTPO group was 10 (6-14) days, which was shorter than 11 (8-23) days in the control group (P < 0.001). The median PLT transfusion requirement in the rhTPO group during APBSCT was 15(0-50)U, which was less than 20 (0-80)U in the control group (P =0.001). At +14 days after transplantation, the proportions of patients with PLT≥50×109/L in the rhTPO group and the control group were 66.3% and 52.2%, while the proportions of patients with PLT≥100×109/L were 23.8% and 11.9%, respectively, with no significant differences (all P >0.05). At +100 days after transplantation, the proportion of patients with PLT≥50×109/L in rhTPO group and control group was 96.3% and 89.6%, respectively (P >0.05), but the proportion of patients with PLT≥100×109/L in rhTPO group was higher than that in control group (75.0% vs 55.2%, P =0.012). There was no difference in the overall incidence of bleeding events in different locations during period of low PLT level of patients between the two groups. In rhTPO group, the rhTPO administration was well tolerated, and the incidences of abnormal liver and kidney function and infection were similar to those in the control group. When MM patients undergo first-line APBSCT, subcutaneous injection of rhTPO can shorten the time of platelet engraftment, reduce the transfusion volume of blood products, and be well tolerated, moreover, more patients have achieve a high level of PLT recovery after transplantation, which is very important for ensuring the safety of APBSCT and maintenance therapy.

Clinical analysis of 11 cases multisystem inflammatory syndrome associated with SARS-CoV-2 Omicron variant infection in children

Objective: To explore the clinical characteristics, diagnosis, treatment, and follow-up of multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 Omicron variant infection. Methods: A retrospective analysis was conducted on clinical data of 11 children with MIS-C, who were admitted to the Department of Pediatrics of Peking University First Hospital from December 2022 to January 2023. Clinical characteristics, treatment, and follow-up of MIS-C were summarized in this study. Results: The 11 cases contained 7 boys and 4 girls, with an age of 4.4 (2.0, 5.5) years on admission. All the patients had fever, with a duration of 7(5, 9) days. Other clinical manifestations included rash in 7 cases, conjunctival hyperemia in 5 cases, red lips and raspberry tongue in 3 cases, lymphadenopathy in 3 cases, and swollen fingers and toes in 2 cases. There were 8 cases of digestive symptoms, 8 cases of respiratory symptoms, and 3 cases of nervous system symptoms. Eight patients had multi-system injuries, and one of them had shock presentation. All 11 patients were infected with SARS-CoV-2 Omicron BF.7 variant. The laboratory examination results showed that all cases had elevated inflammatory indicators, abnormal coagulation function and myocardial damage. Six patients had elevated white blood cell counts, 5 cases had liver function abnormalities, 3 cases had kidney function abnormalities, and 8 cases had coronary artery involvement. All 11 patients received anti-infection treatment, of which 3 cases received only 2 g/kg intravenous immunoglobulin (IVIG), while the remaining 8 cases received a combination of IVIG and 2 mg/(kg·d) methylprednisolone. Among the 8 cases with coronary artery disease, 6 cases received low molecular weight heparin anticoagulation therapy. All patients were followed up in 2 weeks after being discharged, and their inflammatory markers had returned to normal by that time. The 8 cases with coronary artery disease and 3 cases with pneumonia showed significant improvement or back to normal at the 4-week follow-up. All patients had no new complications or comorbidities during follow-up of more than 3 months. Conclusions: MIS-C may present with Kawasaki disease-like symptoms, with or without gastrointestinal, neurological, or respiratory symptoms. Elevated inflammatory markers, abnormal coagulation function, and cardiac injury contribute to the diagnosis of MIS-C. IVIG and methylprednisolone were the primary treatments for MIS-C, and a favorable short-term prognosis was observed during a follow-up period of more than 3 months.

Review of the limitations of current biomarkers in acute kidney injury clinical practices.

Acute kidney injury is a prevalent disease in hospitalized patients and is continuously increasing worldwide. Various efforts have been made to define and classify acute kidney injury to understand the progression of this disease. Furthermore, deviations from structure and kidney function and the current diagnostic guidelines are not adequately placed due to baseline serum creatinine values, which are rarely known and estimated based on glomerular function rate, resulting in misclassification of acute kidney injury staging. Hence, the current guidelines are still developing to improve and understand the clinical implications of risk factors and earlier predictive biomarkers of acute kidney injury. Yet, studies have indicated disadvantages and limitations with the current acute kidney injury biomarkers, including lack of sensitivity and specificity. Therefore, the present narrative review brings together the most current evidenced-based practice and literature associated with the limitations of the gold standard for acute kidney injury diagnoses, the need for novel acute kidney injury biomarkers, and the process for biomarkers to be qualified for diagnostic use under the following sections and themes. The introduction section situates the anatomy and normal and abnormal kidney functions related to acute kidney injury disorders. Guidelines in providing acute kidney injury definitions and classification are then considered, followed by a discussion of the disadvantages of standard markers used to diagnose acute kidney injury. Characteristics of an ideal acute kidney injury biomarker are discussed concerning sensitivity, specificity, and anatomic location of injury. A particular focus on the role and function of emerging biomarkers is discussed in relation to their applications and significance to the prognosis and severity of acute kidney injury. Findings show emerging markers are early indicators of acute kidney injury prediction in different clinical settings. Finally, the process required for a biomarker to be applied for diagnostic use is explained.

A Investigation of Kidney Function in the Hypo-Thyroidism Individuals at the Tertiary Healthcare Centre

The most prevalent endocrine illnesses worldwide are thyroid disorders. India is also no different. There are thought to be 42 million thyroid ailment sufferers in India, based on projections from numerous research on the condition. to investigate Kidney function in hypo-thyroid individuals at a tertiary medical facility. This cross-sectional investigation was conducted over a one-year period in 100 hypo-thyroid individuals at a Medical College and Hospital in Central India after receiving approval from the institutional ethical committee. The investigation includes similar euthyroid participants in addition to the diagnosed hypo-thyroidism individuals who provided consent. Both groups underwent the kidney function test, which included indicators such as creatinine clearance, creatinine urea, and uric acid, among others. Unpaired t-test statistics were computed using SPSS version 22 software. 49 -16%, 50-59 12%, and &gt;60 10%. Women individuals made up 66% of the total population, with male individuals making up 24%. The Creatinine Clearance was considerably poorer in the hypo-thyroidism individuals compared to controls, measuring 102.08±9.98, 80.74±10.56 (P 0.001), Creatinine -0.82±0.102, 0.726±0.0456 (P 0.001), Urea -28.18±3.18, 21.82±3.01 (P 0.001), and Uric acid - 5.082±0.7614, 3.124±0.158 (P 0.001). According to the results of our investigation, the majority of hypo-thyroid individuals were women and in the age range of 30-39. They also demonstrated significantly abnormal kidney function tests, such as lower creatinine clearance and higher creatinine, urea, and uric acid levels in comparison to euthyroid individuals.

Nephrological Complications in Hemoglobinopathies: SITE Good Practice

Background. Hemoglobinopathies, among which thalassemic syndromes (transfusion-dependent and non-transfusion dependent thalassemias) and sickle cell disease (SCD), are the most widespread monogenic diseases worldwide. Hemoglobinopathies are endemic and spread-out all-over Italy, as result of internal and external migration flows. Nowadays, the increase therapeutic options associated to the general aging of patients with hemoglobinopathies related to the improvement in clinical management, contribute to the abnormalities in kidney function going from blood and urine test alterations to chronic kidney disease and end stage renal disease. Methods. Here, we carried out a revision of the literature as panel of recognized experts in hemoglobinopathies with the consultancy and the revision of two nephrologists on kidney alteration and kidney disease in patients with TDT, NTDT and SCD. This is part of the action of the Italian society for the study of thalassemia and hemoglobinopties (SITE). The purpose of this “good practice (GP)” is to provide recommendations for follow-up and therapy for the management of kidney alterations in patients with TDT, NTDT and SCD. The literature review covers the period 1.1.2016 to 31.12.2022. In consideration of the rarity of these diseases, the analysis was extended from 5 to 7 years. Moreover, in the absence of relevant scientific papers in the identified time frame, we referred to pivotal or population studies, when available. Finally, in the absence of evidence-based data from prospective and randomized trials, the authors had to refer to expert opinion (expert consensus) for many topics. Results. We generated question and answer boxes to offer a friendly consultation, using color code strategy and focused answers. Conclusions. The present GP will help in improving the clinical management, and the quality of care of patients with hemoglobinopathies.

Influence of Pre-Transplant Estimated Glomerular Filtration Rate (eGFR) on Outcomes after Allogeneic Hematopoietic Cell Transplantation

Assessment of pre-transplant renal function as measured by estimated Glomerular Filtration Rate (eGFR) is a standard criterion for selection of patients for allogeneic hematopoietic cell transplantation (alloHCT). Despite refinements in alloHCT and reductions in toxicity over time, we hypothesized that baseline renal function is still independently associated with differences in outcomes in the contemporary era. The aim of this study was to identify an optimal eGFR cut point for identifying those at increased risk of HCT-related mortality. Patients who underwent first alloHCT from January 2012 to December 2021 were identified from our institutional database, excluding syngeneic and umbilical cord grafts. eGFR was calculated using the CKD-EPI Creatinine Equation (Inker et a. NEJM 2021). Optimal pre-HCT eGFR cut point for high-risk of non-relapse mortality (NRM) after alloHCT was identified using Cox restricted cubic spline plot. eGRF was grouped into multiple categories based upon the observed association in the spline plot alone with an established cut point of 90 ml/min/1.73 m² for abnormal kidney function. Associations of eGFR, demographics, prognostic factors, and HCT characteristics with NRM and overall survival (OS) were evaluated using survival analysis; non-HCT related death was considered as a competing risk in the NRM analysis. 724 adult patients were studied with a median age of 58 yrs (range, 18-79), 57% males, 92% Caucasian, and 76% KPS &amp;gt;90. HCT-CI: 52% high, 31% intermediate, and 17% low risk. Transplants included 43% myeloablative and 57% reduced-intensity conditioning; 64% peripheral blood and 36% bone marrow grafts. Donor type: 28% related, 55% unrelated and 17% haploidentical. The median (IQR) of pre-transplant eGFR was 96.7 ml/min/1.73 m² (79.6, 107.5). eGFR was categorized as &amp;lt;70 (15.8%), 70-89 (22.4%), 90-119 (52.4%), and &amp;gt;120 ml/min/1.73 m² (9.4%). NRM was significantly higher for the eGFR &amp;lt;70 ml/min/1.73 m² group compared to the others (3-year NRM: 44.9% in eGFR &amp;lt;70 vs 25.0% in 70-89, 23.6% in 90-119, and 13.8% in &amp;gt;120 ml/min/1.73 m²) which was confirmed on multivariate analysis (Figure and Table). Overall survival (OS) was also significantly worse for those with an eGFR &amp;lt;70 ml/min/1.73 m² on multivariate analysis (3-year OS: 34.1% in eGFR &amp;lt;70 vs 51.7% in 70-89, 52.4% in 90-119, and 64.8% in &amp;gt;120 ml/min/1.73 m²) (Table) along with baseline KPS and high ASBMT Request for Information (RFI). The most common causes of death for both the eGFR&amp;lt;70 and &amp;gt;70 ml/min/1.73 m² groups were relapse (44% vs 60%, respectively) and infection (25% vs. 19%, respectively). Both NRM and OS differences among the 3 higher eGFR groups were not statistically significant in multivariate analyses. eGFR was not associated with relapse. We conclude that pre-transplant eGFR &amp;lt;70 ml/min/1.73m 2 is an independent prognostic factor for mortality after alloHCT. Future investigation with larger subgroup analyses regarding specific diagnoses, conditioning regimens and transplant modalities may further identify which patients are more appropriate for transplant and those who may benefit from alternative treatment approaches. Our results also suggest that additional efforts to preserve renal function prior to transplant by limiting nephrotoxic exposures may have implications for optimizing outcomes after transplant, particularly in those with other comorbidities.

Lead Contamination in Driver's Blood and Its Effects on Erythrocytes, Leukocytes, and Platelets as A Biomarker

Lead as a component of air pollution has broad toxic effects and can be detrimental to humans, such as causing abnormalities in kidney function, digestive tract, nervous system, and hematopoietic disorders. Many people carry out their activities on the highway, one of which is an Angkot driver. Drivers who work on the road daily get direct exposure to air pollution, especially from lead (Pb). Therefore they are very vulnerable to the negative effects of lead (Pb). This study aimed to measure blood lead levels as a biomarker of lead contamination in a driving group in Palembang City. The subjects were drivers who had been working for more than 20 years (average 28 years) and the average age was 58 years. Testing blood lead levels using the APHA method and examining erythrocytes leukocytes and platelets using the impedance method and correlation test using the Spearman test. Based on the results of this study, there is a relationship between blood lead levels and erythrocyte (significance: 0.0019) and leukocyte (significance: 0.002) values, but there is no relationship between blood lead levels and platelet values (significance: 0.4), while blood lead levels in drivers are still within the threshold limit (average: 14.9804 µg/L).

Prospective affirmative therapeutics of cannabidiol oil mitigates doxorubicin-induced abnormalities in kidney function, inflammation, and renal tissue changes

Nephropathy is the decline in kidney function. A promising treatment for numerous types of illness is using natural materials as natural chemical compounds. The inquiry was conducted to investigate cannabidiol (CBD) potential for renal syndrome protection. The five equal groups of fifty male Sprague-Dawley rats weighing 150 ± 25 g each were designed; group I received distilled water orally, while group II got an intraperitoneal injection of doxorubicin (18 mg/kg bwt). Group III received CBD (26 mg/kg bwt) orally, while group IV received 1 ml of CBD (26 mg/kg bwt) and group V received trimetazidine (10 mg/kg bwt), in addition to a single intraperitoneal dose of doxorubicin (18 mg/kg bwt) on the 11th day for both groups (IV, V). The administration of CBD (26 mg/kg bwt) led to a noticeable improvement in oxidative stress parameters (SOD and GSH) in rats by significantly lowering enzyme activity (ALT and AST), as well as serum creatinine and urea, IL-6, and MDA, confirming the anti-inflammatory accuracy of CBD linked to significant lowering to IL6R DNA frequency concentration in line with histopathology results. As a result of its anti-inflammatory and antioxidant capabilities, cannabidiol may have protective quality, and CBD medication could be related to controlling renal problems.

Evaluating Chatgpt As an Adjunct for Analyzing Challenging Case

Introduction Despite the rapid development of medicine, clinicians still faced with many challenging cases in practice. For challenging cases, most inexperienced doctors are unable to make a clear diagnosis in the first place, resulting in misdiagnosis and delayed disease. Recently, OpenAI released a new Chatbot model, called ChatGPT (Generation Pre training Converter), which is an artificial intelligence (AI) system that uses reinforcement learning model based on human feedback for training. There have been many research reports on the application of ChatGPT in the medical field, and it has been proven to have a wide range of clinical applications. In our study, we aimed to assess the accuracy and reliability of ChatGPT in diagnosing and treating challenging case. Methods We provided 2 challenging cases. Case 1 provided a medical history and auxiliary test results for ChatGPT, and then ChatGPT answered the possible diagnosis, diagnostic basis, further auxiliary examination and treatment. Case 2 provides negative symptoms and auxiliary test results for ChatGPT, which answers all possible diagnoses. Conduct a comprehensive evaluation and scoring of the results of ChatGPT responses by 5 senior physicians. A score of 10 is the perfect score. Results The analysis results of 2 challenging cases by ChatGPT were comprehensively evaluated by senior experienced professional doctors and scored 9 points. We found that ChatGPT's analysis of challenging case is comprehensive. Especially for the diagnosis and treatment of diseases, ChatGPT analyzes all possible diagnoses and provides accurate treatment plans through the provided medical history, auxiliary examination results, and treatment processes. ChatGPT can directly interpret the auxiliary examination results, such as high level of procalcitonin (PCT), abnormal kidney function, and with negative results can rule out certain diseases, such as ANA, ENA, and ANCA negative, ruling out the possibility of autoimmune diseases. ChatGPT can summarize all the diagnoses including rare diseases, based on the results of an auxiliary test, and explain the cause of the disease and the pathogenesis in detail. Conclusions Our study shows that ChatGPT can provide important reference value as an adjunct to clinicians in challenging case analysis. In particular, it can assist inexperienced doctors in remote areas and underdeveloped medical conditions to make clear diagnosis and treatment as soon as possible, avoid unnecessary referral to higher-level hospitals, reduce medical burden, and reduce waste of medical resources. In the medical field, ChatGPT needs more research to evaluate in clinical applications and become a better adjunct tool in clinical work.