Kidney Function Status Research Articles

DPP-4 enzyme deficiency protects kidney from acute ischemia-reperfusion injury: role for remote intermittent bowel ischemia-reperfusion preconditioning.

We analyzed the effects of acute ischemia-reperfusion (KIR) injury on the status of kidney function and architecture in dipeptidyl peptidase4-difficient (DPP4D) rats and the effect of remote small bowel ischemia-reperfusion (BIR) preconditioning. DPP4-deficient (DPP4D) and normal Fischer344 (F344) rats were divided into 6 groups: (1) sham-F344, (2) sham-DPP4D, (3) KIR-F344 (4) KIR-DPP4D, (5) DPP4D-KIR-extendin-9-39 and (6) BIR-KIR-F344. Blood creatinine and urea nitrogen levels and the urinary protein-to-creatinine ratio was higher in KIR-F344 rats than BIR-KIR-F344 or KIR-DPP4D rats 72 h after acute KIR. Conversely, the circulating glucagon-like peptide 1 (GLP-1) levels were higher in BIR-KIR-F344 and KIR-DPP4D than KIR-F344 rats after acute KIR. KIR-F344 rats showed greater inflammation, oxidative stress, apoptosis, DNA damage and kidney injury than other rat groups. Damage to the kidney architecture in KIR-F344 rats was greater than in BIR-KIR-F344 or KIR-DPP4D rats. Expression of antioxidant proteins and GLP-1 receptor was higher in kidneys from KIR-DPP4D and BIR-KIR-F344 than KIR-F344 rats, which suggests better intrinsic responses. We therefore suggest that elevated circulating GLP-1 levels due to DPP4 deficiency and BIR preconditioning protect kidney function and architecture during acute IR injury.

Association of Parameters of Mineral Bone Disorder with Mortality in Patients on Hemodialysis according to Level of Residual Kidney Function.

The relationship between mineral and bone disorders and survival according to residual kidney function status has not been previously studied in patients on hemodialysis. We hypothesized that residual kidney function, defined by renal urea clearance, modifies the association between mineral and bone disorder parameters and mortality. The associations of serum phosphorus, albumin-corrected calcium, intact parathyroid hormone, and alkaline phosphatase with all-cause mortality were examined across three strata (<1.5, 1.5 to <3.0, and ≥3.0 ml/min per 1.73 m2) of baseline residual renal urea clearance using Cox models adjusted for clinical characteristics and laboratory measurements in 35,114 incident hemodialysis patients from a large United States dialysis organization over the period of 2007-2011. A total of 8102 (23%) patients died during the median follow-up of 1.3 years (interquartile range, 0.6-2.3 years). There was an incremental mortality risk across higher serum phosphorus concentrations, which was pronounced among patients with higher residual renal urea clearance (Pinteraction=0.001). Lower concentrations of serum intact parathyroid hormone were associated with higher mortality among patients with low residual renal urea clearance (i.e., <1.5 ml/min per 1.73 m2), whereas higher concentrations showed a higher mortality risk among patients with greater residual renal urea clearance (i.e., ≥1.5 ml/min per 1.73 m2; Pinteraction<0.001). Higher serum corrected total calcium and higher alkaline phosphatase concentrations consistently showed higher mortality risk (Ptrend<0.001 for both) irrespective of residual renal urea clearance strata (Pinteraction=0.34 and Pinteraction=0.53, respectively). Residual kidney function modified the mortality risk associated with serum phosphorus and intact parathyroid hormone among incident hemodialysis patients. Future studies are needed to examine whether taking account for residual kidney function into the assessment of mortality risk associated with serum phosphorus and intact parathyroid hormone improves patient management and clinical outcomes in the hemodialysis population.

Rationale and design of BISTRO: a randomized controlled trial to determine whether bioimpedance spectroscopy-guided fluid management maintains residual kidney function in incident haemodialysis patients

BackgroundPreserved residual kidney function (RKF) and normal fluid status are associated with better patient outcomes in incident haemodialysis patients. The objective of this trial is to determine whether using bioimpedance technology in prescribing the optimal post-dialysis weight can reduce the rate of decline of RKF and potentially improve patient outcomes.Methods/Design516 pateints commencing haemodialysis, aged >18 with RKF of > 3 ml/min/1.73 m2 or a urine volume >500 ml per day or per the shorter inter-dialytic period will be consented and enrolled into a pragmatic, open-label, randomized controlled trial. The intervention is incorporation of bioimpedance spectroscopy (BI) determination of normally hydrated weight to set a post-dialysis target weight that limits volume depletion, compared to current standard practice. Clinicians and participants will be blinded to BI measures in the control group and a standardized record capturing management of fluid status will be used in all participants. Primary outcome is preservation of residual kidney function assessed as time to anuria (≤100 ml/day or ≤200 ml urine volume in the short inter-dialytic period). A sample size of 516 was based upon a cumulative incidence of 30% anuria in the control group and 20% in the treatment group and 11% competing risks (death, transplantation) over 10 months, with up to 2 years follow-up.Secondary outcomes include rate of decline in small solute clearance, significant adverse events, hospitalization, loss of vascular access, cardiovascular events and interventions, dialysis efficacy and safety, dialysis-related symptoms and quality of life. Economic evaluation will be carried out to determine the cost-effectiveness of the intervention. Analyses will be adjusted for patient characteristics and dialysis unit practice patterns relevant to fluid management.DiscussionThis trial will establish the added value of undertaking BI measures to support clinical management of fluid status and establish the relationship between fluid status and preservation of residual kidney function in incident haemodialysis patients.Trial registrationISCCTN Number: 11342007, completed 26/04/2016; NIHR Portfolio number: CPMS31766; Sponsor: Keele University

Longitudinal Assessment of PTH in Community-Dwelling Older Women-Elevations Are Not Associated With Mortality.

Context:In older women, the magnitude of elevated parathyroid hormone (PTH) and its consequence is unclear.Objective:To describe normal PTH profiles over time and the association with mortality.Design and Participants:There were 1044 community-dwelling women in the Malmö Osteoporosis Prospective Risk Assessment cohort (OPRA) who attended baseline (age 75 years). Follow-ups were attended by 715 (age 80 years) and 382 (age 85 years).Main Outcome Measures:PTH, estimated glomerular filtration rate (eGFR), 25-hydroxyvitamin D (25OHD) and mortality.Results:At age 75 years, PTH levels for most (n = 877, 88%) were within the normal reference range (NRR) (i.e., <6.9 pmol/L). Longitudinally, between ages 75 and 80 years, PTH increased in 60% of all women (n = 390) but increases of up to 50% above baseline values (64%; n=250) still resulted in PTH levels within the NRR. These women had lower 25OHD levels (74 vs 83 nmol/L, P = 0.001). Only when increases were >50% was PTH elevated beyond the NRR (mean 7.1 ± 3.3). Here, a pronounced decline in eGFR (56 vs 61 mL/min/1.73 m2, P = 0.002) was found, despite no further changes in 25OHD. Extending the observational period until age 85 years gave similar results. Baseline PTH levels above NRR were associated with mortality (hazard ratio, 1.4; 95% confidence interval (CI), 1.1-1.8; P = 0.007), although not after adjustment for covariates (P = 0.082).Conclusions:Most women remained within normal PTH ranges despite large increases of up to 50%. PTH elevated above normal is not independently associated with mortality; impaired kidney function and low 25OHD status may be more prognostic in the very old.

Current posttraumatic stress disorder and exaggerated threat sensitivity associated with elevated inflammation in the Mind Your Heart Study

ObjectiveElevated inflammation has been repeatedly observed in posttraumatic stress disorder (PTSD), and it may drive the development of both psychiatric symptoms and physical comorbidities. However, it is not clear if elevated inflammation is a feature of both remitted and current PTSD, and little is known about relationships between specific clusters of PTSD symptoms and inflammation. Exaggerated threat sensitivity, as indexed by threat reactivity and avoidance of perceived threats, may be particularly closely associated with inflammation. MethodsWe assessed PTSD symptoms and threat sensitivity using the Clinician Administered PTSD Scale in 735 Veterans Affairs patients (35% current PTSD; 16% remitted PTSD) who participated in the Mind Your Heart Study (mean age=59±11; 94% male). High sensitivity C-reactive protein (hsCRP), white blood cell count (WBC), and fibrinogen were used as indices of inflammation. Analysis of covariance models with planned contrasts were used to examine differences in inflammation by PTSD status, adjusting for age, sex, race, kidney function and socioeconomic status. ResultsIndividuals with current PTSD had significantly higher hsCRP and WBC than patients with no history of PTSD, but there were no significant differences in inflammatory markers between those with remitted versus no history of PTSD. Within patients with current PTSD, higher threat reactivity was independently associated with higher hsCRP (β=0.16, p=0.01) and WBC count (β=0.24, <0.001), and higher effortful avoidance was associated with higher fibrinogen (β=0.13, p=0.04). ConclusionOur data indicate that elevated inflammation may be a feature of current, but not remitted, PTSD. Within patients with PTSD, higher threat reactivity was also associated with elevated inflammation. A better understanding of the relationship between threat sensitivity and inflammation may inform interventions for patients with PTSD.

Both Diet and Exercise Are Necessary for Obese CKD Patients: A Pilot Prospective Randomized Controlled Study

Aim: This study aimed to examine the effects of exercise training on kidney function and nutrition status in obese Chronic Kidney Disease (CKD) patients. Methods: This is a prospective randomized controlled trial. Twelve adult obese CKD patients were randomly assigned to dietary instruction alone group (Group-D) or to both dietary instruction and exercise training group (Group-E). All patients received supervised dietary advice including calorie, protein, and salt intake for a period of 12 weeks. In addition, patients in Group-E underwent a fitness-training program. A change in glomerular filtration rate (GFR) was the main outcome. Secondary outcomes were changes in body mass index, serum creatinine-based estimated-GFR, serum albumin, and albuminuria. Results: Changes in GFR and all secondary outcomes were not statistically significant in either of the two groups. Although exercise training did not appear to significantly affect serum albumin levels in either group, it did present with a large sized effect. Conclusion: Exercise training might not have any effect on kidney function; however, the combination of exercise training along with dietary advice may prove to be more effective in maintaining the nutrition status when compared with dietary instructions alone in obese CKD patients. These results suggest that appropriate exercise training with dietary instructions is recommended for the treatment of obese CKD patients.

Cross-sectional study of the association between functional status and acute kidney injury in geriatric patients.

BackgroundPatients with chronic kidney disease tend to have impaired functional status, and this can increase the risk of morbidity and mortality. However, no previous studies have rigorously evaluated the relationship between incident acute kidney injury (AKI) and functional status of elderly patients.MethodsElderly patients (≥65 years-old) were prospectively from the general medical wards of a single medical center in Taiwan between January, 2014 and August, 2014. These patients were divided into those with and without AKI at initial presentation, according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. Functional status was assessed by Barthel Index on admission. Multiple regression analyses were utilized to investigate the relationship between AKI and functional status.ResultsOne hundred and fifty-two elderly patients were recruited, 38.9 % of whom had AKI. Patients with AKI at admission had significantly higher mean Charlson Comorbidity Index score (p = 0.05) and borderline lower mean Barthel Index score (34.5 vs. 43.1; p = 0.08), and a significantly lower bladder continence subscale (5.4 vs. 7.0; p = 0.05). Multiple regression analyses indicated that the presence of AKI at admission was associated with a significantly lower Barthel Index score (p = 0.04). Increasing AKI severity (higher KDIGO stage) was also associated with significantly lower Barthel Index score (p <0.01).ConclusionsThis study documented a close relationship between AKI and functional status in the elderly. Interventions that aim to restore functional status might help to lower the risk of AKI in the elderly.

Loop Diuretics Strategies in Acute Heart Failure: From Clinical Trials to Practical Application.

Although loop diuretics are the most commonly used drugs for the treatment of acute heart failure (AHF), their short and long-term effects are relatively unknown. The use of loop diuretics is essential in the management of HF, particularly during episodes of acute decompensation, therefore more than 90% of patients admitted with HF receive this drug. The administration of intravenous loop diuretics to patients with heart failure and congestion typically results in the improvement of dyspnea, pulmonary congestion and in the reduction of Left Ventricular (LV) filling pressures. However, little is known about its appropriate dose, timing and modality administration in patients with AHF: several side effects may result from the administration of high diuretics dose, including worsening kidney function, diuretic resistance and sympathetic overdrive. Furthermore, there is no specific strategy that shows a clear benefit in HF outcome in relation to continuous versus intermittent administration modalities. Current data based on small and heterogeneous studies did not demonstrate a clear risk benefit ratio and larger prospective trials need to be completed in order to be able to provide definitive recommendations in the future. Since every patient represents a single entity and may have different responses to the same treatment, the best clinical approach should take into account physical examination, neuro-hormonal overdrive and kidney functional status. Due to these reasons, treatment with loop diuretics should be specifically customized for each patient, until multicenter blinded trials will provide satisfactory answers regarding optimal dosing, modality administration and precise targets.

Urinary Biomarkers and Risk of ESRD in the Atherosclerosis Risk in Communities Study.

Liver fatty acid binding protein (L-FABP), kidney injury molecule 1 (KIM-1), N-acetyl-β-d-glucosaminidase (NAG), and neutrophil gelatinase-associated lipocalin (NGAL) are urinary markers of tubular injury that may also be markers of chronic kidney damage. We evaluated the association of these markers with incident ESRD in a community-based sample from the Atherosclerosis Risk in Communities Study. This was a matched case-control study of 135 patients with ESRD and 186 controls who were matched on sex, race, kidney function, and diabetes status at baseline (Atherosclerosis Risk in Communities Study visit 4, 1996-1998). Urinary KIM-1 indexed to creatinine (Cr), NAG/Cr, NGAL/Cr, and L-FABP/Cr were measured in stored spot urine samples from the baseline examination. Associations of KIM-1/Cr, NAG/Cr, and NGAL/Cr with patients with incident ESRD through 2008 were modeled continuously and categorically (quartiles) using conditional logistic regression. L-FABP/Cr was modeled only categorically because of a large number of measurements below the lower limit of detection for the assay (2.4 ng/ml). No significant associations were observed for NAG/Cr, NGAL/Cr, or L-FABP/Cr with ESRD. Those in the highest category for KIM-1/Cr had a higher risk of ESRD compared with those with undetectable biomarker levels (reference group) in unadjusted models (odds ratio, 2.24; 95% confidence interval, 1.97 to 4.69; P=0.03) or adjustment for age (odds ratio, 2.23; 95% confidence interval, 1.06 to 4.67; P=0.03). This association was attenuated with additional adjustment for baseline kidney function (odds ratio, 2.02; 95% confidence interval, 0.95 to 4.31; P=0.07 after additional adjustment for eGFR and natural log of the urinary albumin-to-creatinine ratio). No association between KIM-1/Cr and ESRD was found when KIM-1/Cr was analyzed as a continuous variable. Elevated urinary KIM-1/Cr may be associated with a higher risk of incident ESRD, but it does not add to risk prediction after accounting for traditional markers of kidney function in this population.

Participation in a Structured Weight Loss Program and All-Cause Mortality and Cardiovascular Morbidity in Obese Patients With Chronic Kidney Disease

To determine if participation in a weight loss program impacted upon a composite end point of all-cause mortality and cardiovascular morbidity in obese patients with chronic kidney disease (CKD). Retrospective cohort study. All patients with a body mass index (BMI) >30kg/m(2) or >28kg/m(2) with at least 1 comorbidity (hypertension, diabetes, or dyslipidemia) referred to an established weight management program (WMP) from 2005 to 2009 at a metropolitan tertiary teaching hospital were eligible for inclusion in the study cohort. Twelve-month structured weight loss program. Combined outcome of all-cause mortality, myocardial infarction, stroke, and hospitalization for congestive heart failure; kidney transplantation waitlisting. A total of 169 obese patients with CKD commenced the WMP and 169 did not-becoming the observational control group (CON). There were no significant differences between groups for age, BMI, sex, ethnicity, smoking, hypertension, or kidney function at baseline, although CON included more patients with diabetes than WMP (49% vs. 38%, P=.03). Kaplan-Meier survival analysis with log-rank test differed between groups for the combined outcome (P=.03). Cox regression analysis with adjustment for age, sex, ethnicity, hypertension, diabetes, kidney function, baseline BMI, and smoking status, indicated that patients in WMP had a significantly longer event-free period for the combined outcome, than those in CON (adjusted hazard ratio 0.53; 95% confidence interval [CI] 0.29-0.97; P=.04). Participation in the WMP did not increase the likelihood of kidney transplantation waitlisting (odds ratio [OR] 1.06; 95% CI 0.39-2.87; P=.9). Lower baseline BMI and greater weight loss over 12months were the only factors related to kidney transplantation waitlisting (adjusted R(2)=0.426). Participation in a structured weight loss program may be associated with improved outcomes in obese patients with CKD.

Role of serum nitrogen oxide in treated hypertensive and normotensive subjects

Background: Hypertension is a leading cause of mortality and morbidity worldwide. Essential hypertension is characterized by endothelial dysfunction and increased vascular tone and resistance. The former is the result of imbalance of endothelium derived contracting & relaxing factors. Nitric oxide which is produced locally by endothelium is crucial for maintaining vascular tone. Aims & Objectives: To study the role of nitric oxide in hypertensive cases and also find out the normal level of serum nitric oxide in the specific population of the district East Godavari, Andhra Pradesh. Materials M (Male: Female =1.3:1) was taken for the study. Serum creatinine was measured and hypertensives having elevated serum creatinine (>0.3 mg/dl) were excluded from the study; this was done to rule out any effect of kidney functional status on level of serum nitric oxide. Serum nitrate was measured using colorimetric Griess assay. The data was analyzed using SAS 9.1 Results: The mean serum nitrate in hypertensive patients (43.77± 0.29 μmol /L) is higher than the controls (38.57 ±5.02 μmol /L) and is statistically significant p< 0.0002. The concentration of nitrogen oxide (nitrate plus nitrite) in the plasma of systemic venous blood was significantly more in the hypertension group than in the control group. The plasma nitrogen oxide concentration showed a significant positive correlation with both systolic (r=+1.57, p<0.05) and diastolic blood pressure (r=+1.47, p<0.05). Conclusion: Elevated serum nitric oxide level in hypertensives indicates an endothelial cell response to the antihypertensive medications. Serum nitric oxide thus may be used as a marker for predicting “future hypertensive”. This may allow the physicians to modulate life style of these “future hypertensive” before overt hypertension actually develops; this will not only save a probable future hypertensive from taking many medications and facing complications but will also reduce the burden of this ever-growing devastating disease. Also the mean serum nitrate in controls of this study is much different from the other studies; does it indicate that serum nitric oxide value is population specific? Anyway, the authors feel that in order to establish both these points and comment with such conviction, much larger future studies are needed.

Challenges for environmental epidemiology research: are biomarker concentrations altered by kidney function or urine concentration adjustment?

Biomonitoring has become a standard approach for exposure assessment in occupational and environmental epidemiology. The use of biological effect markers to identify early adverse changes in target organs has also become widely adopted. However, the potential for kidney function to affect biomarker levels in the body and the optimal approach to adjustment of biomarker concentrations in spot urine samples for hydration status are two important but underappreciated challenges associated with biomarker use. Several unexpected findings, such as positive associations between urine nephrotoxicant levels and estimated glomerular filtration rate (eGFR), have been reported recently in research using biomarkers. These and other findings, discussed herein, suggest an impact of kidney glomerular filtration or tubule processing on biomarker levels. This is more commonly raised in the context of decreased kidney filtration, traditionally referred to as reverse causality; however, recent data suggest that populations with normal kidney filtration may be affected as well. Misclassification bias would result if biomarkers reflect kidney function as well as either exposures or early biological effect outcomes. Furthermore, urine biomarker associations with eGFR that differ markedly by approach used to adjust for urine concentration have been reported. Associations between urine measures commonly used for this adjustment, such as urine creatinine, and specific research outcomes could alter observed biomarker associations with outcomes. Research recommendations to address the potential impact of kidney function and hydration status adjustment on biomarkers are provided, including a range of approaches to study design, exposure and outcome assessment, and adjustment for urine concentration.

Assessing of the relationship between renal function tests and retinopathy stage in patients with type II diabetes.

Introduction: Retinopathy and nephropathy are long-term diabetes complications which are associated together. Renal dysfunction is a risk factor for progression and deterioration of diabetic retinopathy. Diabetes causes damage to the small blood vessels in the retina and kidney which eventually resulted in diabetic nephropathy, renal failure and blindness. Due to the high cost for treating of these complications it is better to prevent them. Objectives: We aimed to assess the patients’ kidney function and retinal status in a group of diabetic patients to find probable association between nephropathy and retinopathy hence can prevent from serious renal complications. Patients and Methods: In this cross-sectional study 253 patients with type 2 diabetes referring to ophthalmology clinics were evaluated. Eye examination was conducted by an ophthalmologist (vitreoretinal subspecialist) and disease stage was determined, then serum blood urea nitrogen (BUN) and creatinine tests and 24-hour urine collection for microalbuminuria were measured. Results: Mean of BUN and microalbuminuria had significant difference in three groups including proliferative retinopathy, non-proliferative retinopathy and patients without retinopathy. The mean (± SD) of serum creatinine in patients with proliferative retinopathy, non-proliferative retinopathy and patients without retinopathy had no significant difference. Conclusion: The presence or absence of retinopathy in the early stages of diabetic kidney disease has not related to renal involvement, in fact, patients without retinopathy may have renal involvement. In periodic examination, diabetic patients should be evaluated for microalbuminuria in addition to renal function test examination.

Effects of mycophenolate mofetil on kidney function and phosphorylation status of renal proteins in Alport COL4A3-deficient mice.

BackgroundWe investigated the effects of mycophenolate mofetil (MMF) on kidney function and on protein phosphorylation in a mouse model for the human Alport syndrome.MethodsCOL4A3-deficient (COL4A3−/−) mice were randomly allocated to receive a placebo (PLC COL4A3−/−) or MMF treatment (MMF COL4A3−/−). Wild type mice (WT) were used as controls. Changes in serum creatinine, total protein and blood urea nitrogen (BUN), concentrations of mycophenolic acid (MPA) and its glucuronide metabolite (MPAG), serum protein electrophoresis, urine dipstick chemistry and sediment were measured. Changes in the phosphorylation status of renal proteins and histology were analyzed.ResultsMMF influenced kidney function and protein phosphorylation. Serum creatinine and BUN were lower in MMF treated compared to PLC treated COL4A3−/− mice. Serum albumin and alpha-1 globulins were significantly decreased while serum creatinine, alpha-2 globulins, urine dipstick protein, leukocyte esterase, hemoglobin and red blood cells were all increased in both COL4A3−/− groups compared to WT. Differential 2DE-gel analysis identified six phosphorylated kidney protein spots that were significantly altered by MMF.ConclusionsThese data suggest that the MMF treatment in this murine model moderately improved kidney function and reversed the phosphorylation status of six renal phosphoprotein spots to that seen in WT mice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12953-014-0056-z) contains supplementary material, which is available to authorized users.

C234: Correlation between renal tumor size and kidney functional status

C234: Correlation between renal tumor size and kidney functional status

Predictors of 30-day acute kidney injury following radical and partial nephrectomy for renal cell carcinoma

IntroductionPatients with renal cell carcinoma who were treated with radical nephrectomy (RN) or partial nephrectomy (PN) are at risk of postoperative acute kidney injury (AKI), and in consequence, short- and long-term adverse outcomes. We sought to identify independent predictors of 30-day AKI in patients undergoing RN or PN. Materials and methodsBetween 2005 and 2011, patients who underwent RN or PN for renal cell carcinoma within the National Surgical Quality Improvement Program data set were identified. Patients with preexisting severe renal failure, defined as a preoperative estimated glomerular filtration rate<30ml/min/1.73m2, were excluded from the analyses. AKI was defined as an elevation of serum creatinine>2mg/dl above baseline or the need for dialysis within 30 days of surgery. Univariable and multivariable logistic regression analyses were used to examine the association between preoperative factors and the risk of postoperative AKI. ResultsOverall, 1,944 (58.6%) and 1,376 (41.4%) patients underwent RN and PN, respectively. Overall, 1.8% of the patients included in the study experienced AKI within an average of 5.4 days after RN or PN. Independent predictors for AKI included obesity (odds ratio [OR] = 2.24, P = 0.04), history of neurovascular disease (OR = 5.29, P<0.001), and a preoperative chronic kidney disease stage II (OR = 10.00, P = 0.03) or stage III (OR = 26.49, P = 0.02). Furthermore, RN (OR = 2.87, P = 0.02) or the open approach (OR = 2.18, P = 0.04) was significantly associated with postoperative AKI. AKI was significantly associated with adverse postoperative outcomes, such as prolonged length of stay, occurrence of any complication, and mortality (all P <0.001). ConclusionsThe assessment of preoperative kidney function and comorbidity status is essential to identify patients at risk of postoperative AKI. In addition to preoperative chronic kidney disease stages II and III, neurovascular disease, obesity, and surgical approach (RN or open) represent predictors of 30-day AKI. Careful patient selection as well as preoperative planning may help reduce this unfavorable postoperative outcome.

Kidney Function Status in Nigerian Human Malaria Patients

Malaria is now known to affect over 500 million persons worldwide, killing about 1 to 3 million of them annually. Plasmodium falciparum is the species mostly implicated in the causation of severe malaria. This study was carried out to investigate the kidney function status of malaria patients in Benin metropolis, Southern Nigeria, to ascertain if there is renal dysfunction/impairment in them. Plasma levels of sodium, potassium, bicarbonate, urea, creatinine and blood urea nitrogen (BUN) were assayed in a total of 152 subjects (112 malaria patients infected with Plasmodium falciparum and 40 controls) of both sexes, with their age ranging from 8 to 42 years. The results observed irrespective of age or sex, reveal a statistically significant (p<0.05) increase in plasma levels of potassium, urea, BUN and creatinine (4.49±0.95 mmol/L;5.88±0.13mmol /L;16.39±0.36mg/dl and 135.05±2.69imol/L) when compared to their controls (4.05±0.34mmol/L;3.73±0.12mmol/L;10.34±0.36mg/dl and 80.71±1.69imol/L, respectively) and also a statistically significant (P<0.05) reduction in plasma levels of Na+ and HC03- (128.50±0.77 and 19.98±0.28mmol/L) when compared to their controls (l38.58±0.29 and 24.70±0.36mmol/L, respectively). The hyponatraemia and metabolic acidosis observed in the malaria patients are negatively correlated with the degree of parasitaemia (r=-0.241 and r=-0.019, respectively), while the elevated plasma potassium and creatinine levels are positively correlated with the degree of parasitaemia (r=0.153 and r=0.407, respectively). The elevated plasma Urea and BUN levels are also positively correlated with the degree of parasitaemia (r=0.371 and r=0.375, respectively). The results of this study indicate that there is significant renal dysfunction/impairment in patients in southern Nigeria infected with plasmodium falciparum. Keywords : Malaria infection, Kidney function status.

The impact of renal insufficiency on in-hospital outcome in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary interventions

Chronic renal disease (CRD) is a well-known risk factor for bleeding complications in acute coronary syndrome patients. To determine the impact of CRD with ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI) on periprocedural complications. 103 patients with STEMI treated with pPCI were prospectively observed for in-hospital complications and analysed according to kidney function status. Endpoints included clinical and periprocedural outcomes. Major and minor bleedings were reported according to TIMI, REPLACE2 and EASY classifications. Patients with CRD were at greater risk of major bleeding defined by RAPLACE-2 (20.0% vs. 2.7%; p = 0.007) and TIMI(13.3% vs. 1.3%, p = 0.018) classifications and had more grade 2 EASY scale haematomas (20.0% vs. 2.7%; p = 0.007). Vascular access crossover during PCI occurred eight-fold more often among CRD patients (33.3% vs. 4.0%, p < 0.001). Grade 3 TIMI flow was achieved less frequently in CRD patients (60% vs. 89.3%, p = 0.004). CRD predisposed to contrast-induced nephropathy (35.7% vs. 5.7%; p < 0.001) and ischaemic stroke (14.3% vs. 0.0%; p = 0.004). CRD in STEMI patients undergoing pPCI is a risk factor for major and minor bleeding complications including major bleeding, moderate haematomas, contrast-induced nephropathy and ischaemic stroke. Treatment and diagnostic measures should be taken in CRD patients to reduce the severity of periprocedural complications.

Palm kernel oil increases the risk of coronary heart disease in rats compared with ghee

The influence of high fat diets (HFD) containing single fat; palm oil (PO), palm kernel oil (PKO), or ghee on feed efficiency, lipid profile, kidney function and histopathological status of liver and heart of rats were studied. Male adult albino rats were fed on basal diet contained 10% corn oil or HFD that contained either of PO, PKO, corn oil or ghee and 1% cholesterol for twelve weeks. Results showed that feeding rats on HFD containing PO or PKO significantly increased serum total cholesterol, triglycerides and VLDL-C levels compared with those of rats that were fed on basal diet or HFD containing corn oil or ghee. The highest LDL- cholesterol level and the lowest total antioxidant capacity level were recorded in rats that were fed on PKO diet. The histopathological examination showed that feeding rats on HFD diet containing ghee for 12 weeks caused minimum damage to liver cells .Feeding rats on PKO diet caused undesirable histological changes in heart cells. These results indicated that PO and PKO caused more harmful effects on rat's blood serum triglycerides and cholesterol concentrations and liver cells than ghee.

The efficacy and safety of bazedoxifene in postmenopausal women by baseline kidney function status

Introduction Two global, double-blind, placebo- and active-controlled, phase-3 studies (2-year prevention (n = 1583) and 3-year treatment (n = 7492)) have shown that bazedoxifene (BZA) is safe and effective for prevention and treatment of postmenopausal osteoporosis.Objective To evaluate the efficacy/safety of BZA according to baseline kidney function.Methods Data for the BZA 20- and 40-mg and placebo groups from both studies were integrated for assessment of bone turnover markers (BTMs), bone mineral density (BMD), and fracture incidence (treatment study only). Safety was assessed using integrated data for the BZA, placebo, and raloxifene 60-mg groups from both studies. Baseline glomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease Study equation; among subjects with baseline GFR, renal function categories were defined by GFR (ml/min per 1.73 m2): normal (GFR ≥ 90; n = 1982), mild impairment (60 ≤ GFR < 90; n = 6032), or moderate/severe impairment (GFR < 60; n = 723).Results Demographics were similar across treatment groups and within GFR subgroups. Across GFR subgroups, BZA 20 and 40 mg reduced BTM levels and improved lumbar spine and total hip BMD versus placebo. At month 24, there were significant treatment-by-GFR (p = 0.003) and treatment-by-serum creatinine (p = 0.034) interactions for the increase in lumbar spine BMD versus placebo. Fracture incidence was lower with BZA than placebo across all GFR categories, with no treatment-by-GFR interaction. There were no significant differences among treatment groups in incidences of overall, serious, or renal-related adverse events across GFR subgroups.Conclusions Mild to moderate kidney impairment did not affect the efficacy and safety of BZA in postmenopausal women.