Kidney Impairment In Patients Research Articles

The Association Between Triglyceride Glucose-Body Mass Index and Kidney Impairment in Patients with Type 2 Diabetes Mellitus.

Insulin resistance is associated with kidney impairment in patients with type 2 diabetes mellitus (T2DM). The triglyceride glucose-body mass index (TyG-BMI), which combines the TyG index with body mass index (BMI), has received significant attention as a tool for evaluating insulin resistance. Thus, the aim of this study was to explore the association between TyG-BMI and kidney impairment in patients with type 2 diabetes mellitus (T2DM). The cross-sectional analysis included 1080 patients with T2DM, and data were collected retrospectively. TyG-BMI was calculated by fasting blood glucose, triglyceride, and body mass index. TyG-BMI was significantly higher in T2DM patients with albuminuria than those without albuminuria (232.16 [206.52-268.02] vs 229.83 [206.11-255.64], p =0.023). T2DM patients with chronic kidney disease (CKD) showed a significantly higher value of TyG-BMI compared with those without CKD (232.23 [206.46-268.28] vs 229.73 [206.11-255.49], p=0.014). Correlation analysis showed a significantly positive association between TyG-BMI and metabolic parameters including BMI (r = 0.866, p < 0.001), TG (r = 0.630, p < 0.001), TC (r = 0.119, p < 0.001), HDL-C (r = -0.374, p < 0.001), FBG (r = 0.297, p < 0.001), and HbA1c (r = 0.116, p < 0.001) in patients with T2DM. The binary logistic regression analysis found that TyG-BMI was an independent factor for albuminuria (OR = 1.004, 95% CI: 1.001-1.008, p = 0.010) and CKD (OR = 1.005, 95% CI: 1.001-1.008, p = 0.005) in patients with T2DM respectively. The study suggests that TyG-BMI is associated with kidney impairment in patients with T2DM. Given that TyG-BMI is a novel parameter of insulin resistance, the study results indicates that clinicians should pay close attention to screening for kidney impairment in T2DM patients with insulin resistance.

Renoprotective Effects of Metabolic Surgery Versus GLP1 Receptor Agonists on Progression of Kidney Impairment in Patients with Established Kidney Disease.

To examine the renoprotective effects of metabolic surgery in patients with established chronic kidney disease (CKD). The impact of metabolic surgery compared with glucagon-like peptide-1 receptor agonists (GLP-1RA) in patients with established CKD has not been fully characterized. Patients with obesity (body mass index ≥30kg/m 2 ), type 2 diabetes, and baseline estimated glomerular filtration rate (eGFR) 20-60mL/min/1.73 m² who underwent metabolic bariatric surgery at a large US health system (2010-2017) were compared with nonsurgical patients who continuously received GLP-1RA. The primary end point was CKD progression, defined as a decline of eGFR by ≥50% or to <15mL/min/1.73m 2 , initiation of dialysis, or kidney transplant. The secondary end point was the incident kidney failure (eGFR <15mL/min/1.73m 2 , dialysis, or kidney transplant) or all-cause mortality. 425 patients, including 183 patients in the metabolic surgery group and 242 patients in the GLP-1RA group, with a median follow-up of 5.8 years (IQR, 4.4-7.6), were analyzed. The cumulative incidence of the primary end point at 8 years was 21.7% (95% CI: 12.2-30.6) in the surgical group and 45.1% (95% CI: 27.7 to 58.4) in the nonsurgical group, with an adjusted hazard ratio of 0.40 (95% CI: 0.21 to 0.76), P =0.006. The cumulative incidence of the secondary composite end point at 8 years was 24.0% (95% CI: 14.1 to 33.2) in the surgical group and 43.8% (95% CI: 28.1 to 56.1) in the nonsurgical group, with an adjusted HR of 0.56 (95% CI: 0.31 to 0.99), P =0.048. Among patients with type 2 diabetes, obesity, and established CKD, metabolic surgery, compared with GLP-1RA, was significantly associated with a 60% lower risk of progression of kidney impairment and a 44% lower risk of kidney failure or death. Metabolic surgery should be considered as a therapeutic option for patients with CKD and obesity.

Correlation of eGFR values estimated by different equations based on creatinine and cystatin-C in patients on hemodialysis treatment at Teaching Hospital Karapitiya, Galle, Sri Lanka

The present study was to compare eGFR values estimated from different equations based on creatinine and cystatin-C in patients on hemodialysis treatment. eGFR values were calculated using Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology equations based on Creatinine (CKD-EPICr) and cystatin-C values alone (CKDEPI Cys C) and by their combination (CKD-EPICr-Cys C), using 40 pre-dialysis samples. No significant differences in renal function parameters and eGFR were observed, either between male (55%) and female (45%) patients or within different age groups (p&gt;0.05). Certain levels of agreement (p&gt;0.05) were observed between the equations, except for the values derived from CKD-EPICys C and CKD-EPICr-Cys C (p = 0.022). Significant positive correlations were observed between all selected equations. The highest correlation was observed between CKD-EPICr and MDRD (r = 0.998, p = 0.000), whereas the lowest correlation was found between MDRD and CKD-EPICys C (r = 0.552, p = 0.000). The present findings revealed that MDRD and CKD-EPICr equations are suitable for the calculation of eGFR in routine local clinical settings for the assessment of progression of kidney impairment in patients with CKD on hemodialysis treatment. However, the use of CKD-EPICr-Cys C rather than the CKD-EPICys C is recommended as a confirmatory tool where necessary.

Role of Zinc in Diabetic Kidney Disease.

Diabetic Kidney Disease (DKD) represents the most common cause of Chronic Kidney Disease (CKD) in developed countries. Approximately 30% to 40% of diabetes mellitus (DM) subjects develop DKD, and its presence significantly increases the risk for morbidity and mortality. In this context, Zinc seems to have a potential role in kidney and body homeostasis in diabetic individuals as well as in patients at a high risk of developing this condition. This essential element has functions that may counteract diabetes-related risk factors and complications, which include stabilization of insulin hexamers and pancreatic insulin storage and improved glycemic control. In our review, we analyzed the current knowledge on the role of zinc in the management of renal impairment in course of DM. Several studies underline the critical role of zinc in reducing oxidative stress levels, which is considered the common denominator of the mechanisms responsible for the progression of kidney disease. Reaching and maintaining a proper serum zinc level could represent a valuable target to reduce symptoms related to DM complications and contrast the progression of kidney impairment in patients with the high risk of developing end-stage renal disease. In conclusion, analyzing the beneficial role of zinc in this review would advance our knowledge on the possible strategies of DM and DKD treatment.

POS-177 kidney impairment in patients with multidrug-resistant tuberculosis treated in pneumology department of Yalgado Ouédraogo University Hospital (Burkina Faso)

In Burkina Faso, treatment of patients with multidrug-resistant tuberculosis included aminoglycosides until 2019. In 2020, a new protocol was adopted excluding aminoglycosides. Aminoglycosides are nephrotoxic and can lead to chronic kidney disease after (CKD) one or more acute kidney injury (AKI). in this study we report results of a cross-sectional study that identified kidney impairment in patients with multidrug-resistant tuberculosis (MDR-TB) treated with an aminoglycosides protocol. We reviewed the records of MDR-TB patients followed in pneumology department of Yalgado University Hospital between January 1, 2014 and December 31, 2019. Records of patients aged at least 18 years and having completed at least intensive phase of treatment were selected. and sociodemographic, clinical and biological information was collected. kidney impairment was defined by presence of AKI or CKD and/or Nephrotic Range Proteinuria (NRP). For each patient, we collected information from the beginning of the treatment until the last news (end of treatment, death or loss of fellow-up). Quantitative variables were expressed as mean ± standard deviation and qualitative variables as proportion. We found 147 files, including 41 incomplete files, and retained 106 complete files. Patients mean age was 38.3±12 years (Males: 36.6±11.6 years; Females: 42.9 ±11.8 years); sex ratio was 2.78. Hypertension and diabetes were present in one case each. kidney impairment was present in 35 cases (33%): 17 cases was AKI and CKD each; one case was NRP. AKI recovered completely in 5/17 cases. The mean eGFR of MDR-TB patients without kidney impairment and with kidney impairment was respectively 181.4 ± 230 mL/min/1.73 m² and 127.9 ± 56.8 mL/min/1.73 m² at M0. At M9, patients without kidney impairment and with kidney impairment respectively mean eGFR was 135.3 ± 73.2 mL/min/1.73 m² and 75.2 ± 26.1 mL/min/1.73 m².among those who had kidney impairment we had at the latest news: recovery of MDR TB : 29/35; discontinuation of follow-up: 2/35 deceased: 4/35. We found that treatment of MDR-TB with injectable aminoglycosides may be a cause of kidney disease; screening is routinely required for all patients who have been treated with these drug.

Single-cell RNA sequencing data suggest a role for angiotensin-converting enzyme 2 in kidney impairment in patients infected with 2019-novel coronavirus.

Single-cell RNA sequencing data suggest a role for angiotensin-converting enzyme 2 in kidney impairment in patients infected with 2019-novel coronavirus.

Normoalbuminuric kidney impairment in patients with T1DM: insights from annals initiative

BackgroundWe described, in a large sample of patients with type 1 diabetes mellitus (T1DM) and GFR ≤ 60 mL/min/1.73 m2 (with or without albuminuria), the differences in the clinical features associated with the two different chronic kidney disease phenotypes and we investigated, in a subset of patients, the modulating role of albuminuria on kidney disease progression.MethodsClinical data of 1395 patients with T1DM were extracted from electronic medical records.ResultsAlbuminuria was detected in 676 (48.5%) patients, with the remaining 719 (51.5%) patients having normoalbuminuric renal impairment. Those with albuminuria showed an evident worse cardiovascular risk profile as compared to patients with normoalbuminuria. A subgroup of 582 patients was followed up over a 4-year period. One hundred and twenty five patients (21.5%) showed a loss of eGFR > 30%. The proportion of patients reaching the renal outcome was significantly higher among those with baseline albuminuria as compared to patients with normoalbuminuria (P < 0.0001). At the multivariate logistic analysis microalbuminuria, macroalbuminuria and proliferative retinopathy were the only parameters independently associated to eGFR reduction.ConclusionsThe proportion of T1DM patients with normoalbuminuria renal impairment is high (about 50%). These patients have a slower eGFR decline as compared to that observed in patients with albuminuria renal impairment.

Role of Cystatin C and glomerular filtration rate in diagnosis of kidney impairment in hepatic cirrhosis patients.

Hepatic cirrhosis is often accompanied by functional kidney impairment, which may be reversed if early treatment is promptly administered. This study aimed to investigate the role of Cystatin C and Cystatin C estimated glomerular filtration rate in the diagnosis of kidney impairment in patients with hepatic cirrhosis.Four hundred sixty five patients with hepatic cirrhosis were recruited. Serum creatinine and Cystatin C were determined, and their estimated glomerular filtration rates were calculated.The area under the receiver-operating characteristic curve (area under curve [AUC]) of Cystatin C and Cystatin C estimated glomerular filtration rate was significantly larger than that of serum creatinine and serum creatinine estimated glomerular filtration rate, respectively (P = .000). When the optimal cut-off value and upper reference limit were used, similar sensitivity, misdiagnosis rate, and diagnostic consistency were only observed in Cystatin C estimated glomerular filtration rate (P > .05).Cystatin C and Cystatin C estimated glomerular filtration rate are superior to serum creatinine and serum creatinine estimated glomerular filtration rate in diagnosis of secondary kidney impairment, and Cystatin C estimated glomerular filtration rate has a better performance as compared with Cystatin C. However, it is not a measured parameter, and thus the lab should determine its own optimal cut-off value.

White blood cell transcriptome correlates with renal function in acute heart failure.

It is notoriously difficult to classify patients with acute heart failure (AHF) because of variations in clinical presentation, different etiologies, the impact of comorbidities, and variable prognoses. In this study, we used DNA whole-genome microarrays to classify 24 patients with AHF based on the transcriptome of their peripheral blood nuclear cells. The main purpose was to verify whether any transcriptomic sub-clusters had clinical correlations. We identified two distinct groups of transcriptomic profiles that correlated with normal (1.125 mg/dL) and increased (1.783 mg/dL) mean blood creatinine concentrations. These two subgroups of patients (n = 12) differed in the expression of more than 6000 genes and 108 signaling pathways. The most significant regulated signaling pathway was the aldosterone-regulated sodium reabsorption pathway and the most significant regulated genes included the angiotensin-converting enzyme gene. This suggests that kidney impairment in patients with AHF is related to dysregulation of the renin-angiotensin-aldosterone system. The interesting findings of our study were the significant differences in expression of genes belonging to the aldosterone-regulated signaling pathway: Na+/K+ transporting ATPase and NEDD4L (neuronal precursor cell expressed developmentally down-regulated 4-like) between patients with and without renal dysfunction. Future studies of blood-cell transcriptomic profiles in patients with AHF will provide further insights into the molecular pathogenesis of this cardiorenal disorder.

Kidney failure in Townes–Brocks syndrome: An under recognized phenomenon?

Though uncommon, kidney malformations are described in several cases of Townes-Brocks syndrome. By contrast, kidney failure has been reported as the presenting feature of Townes-Brocks syndrome on only one occasion. While the SALL1 gene, mutations of which result in the Townes-Brocks phenotype, is expressed in the developing kidney, the absence of other corroborative reports of kidney failure presenting in affected individuals suggests that the solitary observation of kidney failure is as likely due to chance as to causal association. In now reporting a further instance of this association, we review the literature, demonstrating that several other instances of kidney failure are in fact known, despite an incomplete dataset. These findings suggest that kidney failure may be a constituent element of the natural history of Townes-Brocks syndrome and raise the possible benefits of longitudinal survey for progressive kidney impairment in patients with this syndrome.

The assessment of kidney function by general practitioners in Australian patients with type 2 diabetes (NEFRON‐2)

To examine factors influencing the identification of kidney impairment in patients with type 2 diabetes in Australian primary care. 348 general practitioner investigators were asked to estimate kidney function and its severity in 10-15 consecutively presenting patients with type 2 diabetes (n = 3893). They were then asked, for each patient, whether they routinely estimated kidney function. No instruction was provided on how kidney function should be estimated or categorised. Data were collected between April and September 2005. Kidney function estimated by the Cockcroft-Gault equation using clinical and laboratory data provided by the GP; estimates of kidney function made by the GP. In 24% of the patients with type 2 diabetes, their GP routinely estimated kidney function. However, few of these patients had impaired kidney function or risk factors for kidney disease. There was a good statistical correlation between the estimates made by GPs and the data-derived estimates (R2 = 0.72). GPs identified patients with data-derived estimates of kidney function < 60 mL/min in over 83% of cases, with a specificity of 90%. Impaired kidney function was reported by GPs in 34.4% of men and 36.4% of women. These figures were discordant with function categorisation using both GP estimates and data-derived values, overlapping in half of the patients. Despite GPs' ability to assess creatinine clearance, "raw" (unstandardised) serum creatinine levels inappropriately influenced the perception of impairment of kidney function. GPs can accurately assess kidney function, without reporting of estimated glomerular filtration rate (eGFR). However, even in patients at increased risk of chronic kidney disease, routine estimates are seldom made. Our findings underline the value of the recent initiative recommending automatic reporting of eGFR in Australia.

Differential glycosylation of Bence Jones protein and kidney impairment in patients with plasma cell dyscrasia

Although Bence Jones protein (BJP) is generally accepted to be critically involved in the pathogenic process of kidney impairment in patients with myeloma, patients with BJP do not always have kidney dysfunction. As proteins often undergo glycosylation and alter their molecular nature, it is expected that the heterogeneity in kidney dysfunction can be explained at least partly by the differential affinity to the kidneys of BJP dependent on its glycosylation. Accordingly, we analyzed the structures of carbohydrates of urine BJP biochemically to correlate the structure with kidney function. BJP was obtained from 16 patients with myeloma, 2 patients with light chain amyloidosis, a patient with plasma cell leukemia, and a patient with Waldenström's macroglobulinemia. All BJP had five forms of oligosaccharides: three forms of biantennary oligosaccharides and two forms of triantennaries. The three biantennaries correspond to previously reported oligosaccharides on only λ-type BJP, whereas the triantennaries are novel oligosaccharides found on BJP. Among the five oligosaccharides, the triantennary oligosaccharide Galβ1–4GIcNAcβ1–2Manα1–6αlβ1–4GIcNAcβ1–4(Galβ1–4GIcNAcβ1–2)Manα1–3)Manβ1–4GlcNAcβ1–4GIcNAc showed a significant negative correlation with the serum creatinine level ( p = 0.015 by Spearman's correlation test, R = 0.744). Thus determination of BJP glycosylation may be useful for the evaluation of kidney impairment in patients with BJP.