Low Urine Research Articles

A case of central diabetes insipidus after COVID-19 as a probable diagnosis of lymphocytic infundibulo-neurohypophysitis with positive anti-rabphilin-3A antibodies with review of literature.

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2, and various complications have been reported. Furthermore, there have been increasing reports of endocrinopathy related to COVID-19 following the pandemic. We report a 49-year-old healthy woman who developed rapid onset of polydipsia and polyuria three weeks after COVID-19. Laboratory tests indicated low urine osmolarity and increased serum osmolarity, and antidiuretic hormone (ADH) was undetectable. Urine osmolality remained low with water deprivation. Similarly, plasma ADH responses to hypertonic-saline infusion were blunted and urine osmolality increased in response to desmopressin. There was no clear evidence of anterior pituitary dysfunction. T1-weighted magnetic resonance imaging (MRI) showed pituitary stalk thickening and absence of posterior pituitary bright signal spots, suggesting the presence of hypophysitis. Based on these results, we made a probable diagnosis of lymphocytic infundibulo-neurohypophysitis (LINH) which have caused central diabetes insipidus. Positive findings for serum anti-rabphilin-3A antibodies, reported as a potential diagnostic marker for LINH, were also noted. Following oral desmopressin administration, polydipsia and polyuria were quickly improved, though treatment with desmopressin was still required over four months. This is the first report of a patient with a probable diagnosis of LINH after COVID-19 who tested positive for anti-rabphilin-3A antibodies. Positive findings for those antibodies suggest that pituitary dysfunction associated with COVID-19 is hypophysitis involving an abnormal immune mechanism. The presence of anti-rabphilin-3A antibodies may be useful as a non-invasive diagnostic marker of LINH and potentially serve as a valuable diagnostic aid in cases of LINH associated with COVID-19.

Proximal Renal Tubular Acidosis Complicated by Severe Hypocalcemia Caused by Malnutrition and Inappropriate Long-term Use of Zoledronate: A Case Report and Review of the Literature.

An 80-year-old man presented with electrolyte abnormalities, particularly hypocalcemia (3.6 mg/dL). He was diagnosed with bone and lymph node metastases from prostate cancer seven years earlier and continuously received goserelin, bicalutamide, and zoledronate. He later developed gradually worsening hypocalcemia, hypokalemia, hypophosphatemia, hypouricemia, renal dysfunction, and weight loss. Urinary potassium and phosphate loss, renal glucosuria, metabolic acidosis, and a low urine pH (5.0) were observed. Given the acquired onset and clinical course, we diagnosed the patient with zoledronate-induced proximal renal tubular acidosis. In the present case, severe hypocalcemia may have been caused by malnutrition and inappropriate long-term use of zoledronate.

Evaluation of Effect of Montelukast in the Model of Streptozotocin Induced Diabetic Nephropathy in Rats.

Diabetic nephropathy is a progressive condition and a leading cause of end-stage renal disease. Oxidative stress and inflammation play an important role in its pathogenesis. In pre-clinical studies, Montelukast had shown renoprotective and anti-oxidant properties, hence the study was planned to evaluate the effect of Montelukast in a Streptozotocin (STZ) induced model of diabetic nephropathy. 40 Wistar rats of either sex were randomly divided into four groups viz. 1. Vehicle control group, 2. Enalapril (5 mg/kg), 3. Montelukast low-dose (10 mg/kg) and 4. High-dose (20 mg/kg) group. On day 1, diabetes was induced using a single dose of STZ (60 mg/kg) intraperitoneally. Diabetes induction was verified based on fasting blood glucose (FBG) levels on day 7 and from day 8 to day 42, rats were given study drugs. FBG, serum creatinine, blood urea nitrogen (BUN) and urine microalbumin levels were assessed pre-study and post-study. Assessments of kidney malondialdehyde (MDA), reduced glutathione (GSH) and renal histopathology were carried out at the end of the study. Montelukast 10 mg/kg group showed significantly lower urine microalbumin levels compared to the vehicle control group (p < 0.05). Montelukast 20 mg/kg group showed significantly lower levels of FBG, serum creatinine, BUN and urine microalbumin compared to the vehicle control group (p < 0.05). In addition, Montelukast 20 mg/kg group also showed better effects on kidney MDA and GSH levels (p < 0.05) and histopathological scores compared to the vehicle control group. Montelukast showed a protective effect in the model of diabetic nephropathy because of its antioxidant effect.

Medical Termination of Pregnancy (MToP) in the 1st trimester - the role of human chorionic gonadotropin and ultrasound in pregnancy diagnosis and MToP follow-up.

In the Czech Republic, it is possible, to carry out Medical Termination of Pregnancy (MToP) in the 1st trimester up until the 49th day of secondary amenorrhea. The aim of the study is to analyse the significance of serum/urine human chorionic gonadotropin (hCG) assessment and ultrasound (US) examination in pregnancy diagnosis and MToP follow-up. In 2017-2018, MToP was carried out in a total of 109 women by administering a combination of mifepristone (600 mg orally) and misoprostol (400 mcg orally). Serum/urine (LSUP - low sensitivity urine pregnancy test) hCG assessment and US examination were performed at pregnancy diagnosis and MToP follow-up. At pregnancy diagnosis, there was a positive and medium strong correlation between serum hCG and size of the gestational sac - GS (R = 0.711; P 1,000 IU/L and LSUP test was always positive). In 5.5% of women (6/109), a subsequent surgical intervention was carried out including those with ongoing pregnancy (N = 5); missed abortion (N = 1) was treated by additional misoprostol, where surgical intervention was not necessary. At pregnancy diagnosis, there is a positive and medium strong correlation between serum hCG and CRL. In MToP follow-up, a negative LSUP test enables reliable exclusion of ongoing pregnancy and missed abortion. In case of a positive LSUP test, US examination should be performed; however, surgical intervention should not be indicated solely on the basis of uterine cavity dilatation.

PROFILE OF NITRIC OXIDE METABOLISM INDICATORS IN PRETERM INFANTS WITH PERINATAL CENTRAL NERVOUS SYSTEM INJURIES

Introduction. Premature infants often experience a heightened risk of brain damage, potentially leading to various disorders affecting motor, cognitive, behavioral, social, and sensory functions. The underlying pathological processes of hypoxic-ischemic central nervous system (CNS) injury predominantly stem from compromised cerebral blood flow and oxygen transport. Timely diagnosis and treatment options for prematurely born children with perinatal CNS damage remain limited. Nitric oxide, a universal regulator of physiological functions, plays a crucial role. Endothelial dysfunction, marked by the loss of the neurovascular protective functions of nitric oxide, could significantly contribute to the development of cognitive impairment in hypoxic-ischemic CNS damage. Objectives. The study aims to evaluate the specificities of nitrate metabolism indicators in premature infants with hypoxic-ischemic CNS lesions in the early neonatal period. This involves examining and comparing clinical indicators characterizing hemodynamics, as well as the levels of nitrites, nitrates, and nitrosothiols in urine among patients in the studied groups. Subjects and Methods. The study comprised 14 premature infants with hypoxic-ischemic CNS injury (main group), with a separate selection of 4 infants who did not survive during the neonatal period. The comparison group included 20 relatively healthy prematurely born children. Stratification was based on the results of a genetic study, specifically the determination of the rs61722009 polymorphism of the eNOS gene. The patients underwent routine clinical examinations, including blood pressure measurements, and assessments of nitrates, nitrites, and nitrosothiols in urine. Subgroups were identified as follows: 1st subgroup - 4bb (n=10), and 2nd subgroup - 4aa/4ab (n=10). Results. It was observed that newborns who did not survive had significantly lower systolic and diastolic blood pressure readings on the first day of life, in comparison to relatively healthy children in the two control subgroups (day 1 - p=0.018; p=0.027; p=0.036; p=0.053). Additionally, they exhibited lower heart rate indicators on the first day (p=0.001; p=0.002). However, overall, hemodynamic indicators in newborns with hypoxic-ischemic central nervous system damage did not show statistically significant differences from the corresponding indicators in relatively healthy children. The results indicate a significantly lower level of diuresis in children who died as a result of severe with hypoxic-ischemic central nervous system damage, probably due to the development of multiple organ failure immediately after birth. As a result, it was found that the levels of nitrites (p&lt;0.001; p&lt;0.0001) and nitrates (p&lt;0.01; p&lt;0.0001) were reduced in children with with hypoxic-ischemic central nervous system damage, compared to children in the control groups, regardless of genotype variant. While the level of nitrosothiols did not differ significantly, it was even much higher in children who did not survive, 3.55±0.39 vs 2.23±0.22; p=0.008. The differences found may indicate a disruption of the regulatory effect of nitric oxyde on vascular tone and the condition of neuroglia, particularly in children with hypoxic-ischemic central nervous system damage, as a result of its insufficient production, as well as insufficient mobilization from the depot due to nitrite and nitrate reductases. Conclusions. Hemodynamic patterns in children from the examined groups, except for those who did not survive, did not exhibit significant differences. The notably lower urine output in deceased children indicates the development of multiple organ failure due to severe hypoxia. In children with hypoxic-ischemic central nervous system damage, there is a reduction in the levels of nitrites and nitrates in urine compared to relatively healthy premature infants, while the level of nitrosothiols did not show significant differences and was even notably higher in children who did not survive. The outcome of studying the levels of nitrates, nitrites, and nitrosothiols in urine in a larger patient sample may lead to the development of an algorithm for early diagnosis and management, contingent on the severity of metabolic disorders resulting from hypoxia, considering the potential influence of nitric oxide on energy deficit and mitochondrial dysfunction.

Optimization of Automated Dimethylmethylene Blue Assay for Quantification of Pediatric Urine Samples.

The metachromatic dye dimethylmethylene blue is used to quantify total glycosaminoglycans in urine. Understanding the interaction of dimethylmethylene blue with glycosaminoglycans is pertinent to optimize the assay procedure depending on the type of sample and interpret the findings meaningfully. The present spectrophotometric study determined the optimum sample-to-dye ratio, primary wavelength for measuring absorbance, after studying the interaction of two different chondroitin sulfate species (unfractionated chondroitin sulfate from bovine trachea vs. chondroitin sulfate oligosaccharide with degree of polymerization of 12, from shark cartilage) with dimethylmethylene blue. Respective dye-glycosaminoglycan complexes of the two chondroitin sulfate species showed significantly different absorbance maxima, while that of the chondroitin sulfate oligosaccharide was closer to absorbance maxima of urine glycosaminoglycans. The chondroitin sulfate oligosaccharide showed relatively less stable absorbance readings at higher concentrations in the reaction volume. Furthermore, the chondroitin sulfate reference materials exhibited differences in the linearity of standard curves and hence parallelism. Based on the findings, the method was semiautomated on Beckman Coulter D✕C 700 biochemistry analyzer using the chondroitin sulfate oligosaccharide as the standard. The urine glycosaminoglycan concentration obtained was slightly lower but reasonably close to that obtained through the External Quality Assurance (EQA) scheme administrated by ERNDIM (European Research Network, Inherited Disorders of Metabolism). The findings of the present study can be used to guide the dimethylmethylene blue assay optimization, redevelopment efforts, and harmonization across laboratories. The chondroitin sulfate oligosaccharide is better than the unfractionated chondroitin sulfate from bovine trachea due to its absorbance maxima closer to urine glycosaminoglycans. On the other hand, unfractionated chondroitin sulfate exhibit poor parallelism leading to falsely lower urine glycosaminoglycan levels.

Association of urine dicarboxylic acid levels with intracranial volume–normalized brain regions and with white matter hypo‐intensities

AbstractBackgroundNon‐invasive molecules related to AD imaging biomarkers can reveal disease mechanisms and may help in the mass screening of an aging population. Our study aims to determine if urine dicarboxylic acids (DCA) that changed in AD are coupled with brain volume changes.MethodStudy participants (&gt; 65 years) were recruited in an ongoing HMRI Brain aging study, and MRI data were acquired and analyzed using NeuroQuant. The data were normalized to the intracranial volume (icv). DCAs were quantified using gas chromatography/mass spectrometry. We compared DCA and icv‐normalized brain region volumes in two ways: first, we used descriptive statistics to obtain the median (Q2) for short‐chain DCAs (C4+C5), medium‐chain DCAs (C7+C8+C9) and the ratio of short to medium chain DCAs ((C4+C5)/(C7+C8+C9)). Brain regions were then sorted to correspond to less than (&lt;Q2) or greater than the DCA medians (&gt;Q2). Differences were determined using two‐sample t‐tests and Wilcoxon rank‐sum tests with adjustment for multiple comparisons using FDR. Secondly, icv‐normalized brain regions and T1 hypo‐intensity were compared with DCA levels using a two‐tailed student’s t‐test.ResultThere was no significant difference in the DCA levels of participants with low (icv&lt;Q2) or high icv (icv&gt;Q2) (Fig.1A). In contrast, C4+C5 levels were higher, while C7+C8+C9 were lower in participants with higher whole brain volumes (WBV) (Fig. 1B). In addition, hippocampal volumes were greater when participants had a higher urine C4+C5 and lower C7+C8+C9. We identified 19 other icv‐normalized brain regions that were bigger when urine C4+C5 levels were high. In addition, participants with higher white matter hypo‐intensities had lower urine C4+C5 and a higher C7+C8+C9 DCA levels (Table 1).ConclusionThese data suggest that urine lipid composition is linked to icv‐normalized brain volumes. Higher mitochondrial‐associated lipids reflected larger brain volumes, while oxidized lipids indicated lower brain volumes. Thus, urine lipid levels can be used as surrogate biomarkers in clinical trials targeting brain volume changes. We will use a bigger sample size normalized for ApoE genotype, age, and sex to further examine lipids and brain volumes in participants with different cognitive states.

2818. Investigating Urinalysis Criteria that Predict UTI: Impact of age, sex, and urine culture thresholds

Abstract Background Urinalysis (UA) results are used by clinicians and laboratories to aid in the diagnosis of UTI. However, optimal UA parameters have not been systematically investigated or validated for different populations. Our objectives were to assess the performance of UA in predicting UTI and to stratify UA performance by age, sex, and culture thresholds. Methods We conducted a retrospective cohort study of adult non-catheterized inpatient and ED encounters with paired UA and urine cultures (24 hours apart) from 5 community and academic hospitals in three states (NC, VA, GA) between 01/01/2017 and 12/31/2019. Trained abstractors collected clinical and demographic data for a random sample of patients. Patients were classified as having UTI, asymptomatic bacteriuria or ‘not UTI’ based on IDSA guidelines using signs/symptoms and microbiology data. We evaluated the performance of relevant UA parameters in predicting UTI by assessing sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). We also combined 18 different UA criteria (Figure 1) and used area under receiver operating curves (AUROC) to identify the 5 best-performing models, and stratified results by age, sex, and lower urine culture bacterial threshold (1000 colony forming units). Results Of 219,338 encounters, 3392 charts were included and reviewed; 723 (21.3%) patients met criteria for UTI. Females and older adults had a higher incidence of UTIs and ASB (P&amp;lt; 0.05; Table 1). Absence of pyuria (or leukocyte esterase) had a high NPV for UTI (Table 2). Combined UA parameters performed better than pyuria alone with regards to NPV and AUROC, specifically models 1 and 5 (Table 3). UA parameters used in these models performed differently based on age, sex and urine culture thresholds, with limited utility in older women and UTIs with lower bacterial threshold (Table 4). Conclusion Our review of laboratory and symptom data from a diverse population dataset revealed that combined UA parameters were better at predicting UTI, but performance of UA parameters differs based on age, sex, and urine culture thresholds. Our approach highlights the need to move away from a one-size fits all approach to using population specific UA cut-offs for patients with UTI symptoms. Disclosures Sonali Advani, MBBS, MPH, FIDSA, bioMérieux: Advisor/Consultant|GlaxoSmithKline: Advisor/Consultant Nicholas A. Turner, MD, MHSc, PDI: Research contract to assess efficacy of cleaning agent

Clinical and biochemical alterations associated with excess calcitonin in a dog with medullary thyroid carcinoma

AbstractWe present a 10‐year‐old mongrel dog with progressive weight loss, polyuria and polydipsia. Physical examination revealed poor body condition, systemic hypertension (on average 165 mmHg) and a cervical mass that was confirmed by ultrasound in the right thyroid lobe (diameter 4.0 cm). Blood biochemistry on two different days revealed a low ionised calcium concentration (1.1 and 0.81 mmol/L; reference range: 1.1–1.3 mmol/L) associated with an elevated plasma calcitonin concentration in the same sample (44.8 and 49 pg/mL; reference range: &lt;2 pg/mL). A low urine specific gravity (1.012) was also found. Total thyroxine concentration was low, corresponding to euthyroid sick syndrome. Hypercalcitoninemia, hypocalcaemia and clinical signs resolved after an uncomplicated right thyroidectomy. Positive staining of the neoplasm for calcitonin on immunohistochemistry confirmed a medullary thyroid carcinoma. This is the first report describing the clinical signs and biochemical alterations associated with excess calcitonin in a dog with medullary thyroid carcinoma confirmed by immunohistochemistry.

The Relationship Between Manifestation of Diabetes Insipidus and Estimated Glomerular Filtration Rate in Brain Death.

Systematic reviews have revealed that up to 50% of patients with brain death have residual hypothalamic/pituitary activity based on the absence of central diabetes insipidus (DI). We hypothesized that different degrees of renal dysfunction may impact the presence of DI in patients with brain death. Single-center prospective data collection. ICUs in a tertiary academic hospital. All adult patients declared brain dead over 12 years. None. DI was diagnosed by polyuria, low urine specific gravity, and increasing serum sodium, measured in close proximity. Renal function was assessed by the estimated glomerular filtration rate (eGFR), calculated using the simplified modification of diet in renal disease equation. Analysis was completed in 192 of 234 patients with brain death after excluding those with missing data, those younger than 18 years and those on vasopressin infusions. One hundred twenty-two patients (63.5%) developed DI and 70 patients (36.5%) did not. The proportion of DI decreased significantly with decreasing eGFR: for eGFR greater than 60 mL/min, DI was present in 77.2%; for eGFR 15-60 mL/min, DI was present in 54.5%; for eGFR 14.9-9.8 mL/min, DI was present in 32%; none of the 14 patients with eGFR less than or equal to 9.7 mL/min ever experienced DI ( p < 0.001). Using logistic regression, for every 10 mL/min decrease in eGFR, the odds of DI decreased 0.83 times (95% CI, 0.76-0.90, p < 0.001). Renal dysfunction significantly impacts DI's clinical manifestation in brain death. We report that patients who experience brain death with severe renal dysfunction may not develop clinical signs of DI.

Distinguishing Uric Acid Stone Formers from Type 2 Diabetics with Low Urine pH: The Role of Impaired Buffering

Distinguishing Uric Acid Stone Formers from Type 2 Diabetics with Low Urine pH: The Role of Impaired Buffering

Molecular Mechanism Biomarkers Predict Diagnosis in Schizophrenia and Schizoaffective Psychosis, with Implications for Treatment.

Diagnostic uncertainty and relapse rates in schizophrenia and schizoaffective disorder are relatively high, indicating the potential involvement of other pathological mechanisms that could serve as diagnostic indicators to be targeted for adjunctive treatment. This study aimed to seek objective evidence of methylenetetrahydrofolate reductase MTHFR C677T genotype-related bio markers in blood and urine. Vitamin and mineral cofactors related to methylation and indolamine-catecholamine metabolism were investigated. Biomarker status for 67 symptomatically well-defined cases and 67 asymptomatic control participants was determined using receiver operating characteristics, Spearman's correlation, and logistic regression. The 5.2%-prevalent MTHFR 677 TT genotype demonstrated a 100% sensitive and specific case-predictive biomarkers of increased riboflavin (vitamin B2) excretion. This was accompanied by low plasma zinc and indicators of a shift from low methylation to high methylation state. The 48.5% prevalent MTHFR 677 CC genotype model demonstrated a low-methylation phenotype with 93% sensitivity and 92% specificity and a negative predictive value of 100%. This model related to lower vitamin cofactors, high histamine, and HPLC urine indicators of lower vitamin B2 and restricted indole-catecholamine metabolism. The 46.3%-prevalent CT genotype achieved high predictive strength for a mixed methylation phenotype. Determination of MTHFR C677T genotype dependent functional biomarker phenotypes can advance diagnostic certainty and inform therapeutic intervention.

Known case of ESRD due to IgA nephropathy with myelodysplastic syndrome having perinephric hematoma and disseminated multi-drug resistant Klebsiella pneumonia infection in urinary tract, gastrointestinal tract and testes following living donor kidney transplantation: The strength of multidisciplinary team management

A 34 years old man, had increasing pain over grafted kidney with low urine output on post-operative ‘Day 7’ following living donor kidney transplantation. He was a known case of IgA nephropathy with end stage renal disease and Myelodysplastic Syndrome (MDS). CT abdomen revealed perinephric hematoma; cast effect on graft kidney; and the density over grafted kidney was decreased suggestive of rejection. He also had disseminated multi-drug resistant Klebsiella pneumonia infections in urinary tract, gastrointestinal tract and orchitis. Multi-disciplinary team’s management which includes nephrologists, general physicians, hematologists, uro-surgeons, vascular surgeons, radiologists, microbiologists and anesthetists saves patient’s life as well as transplant kidney.

Understanding the Barriers to Preventive Pharmacological Therapy Use in Older Patients With Urinary Stone Disease.

Despite compelling clinical trial evidence and professional society guideline recommendations, prescription rates of preventative pharmacological therapy (PPT) for urinary stone disease are low. We sought to understand how patient- and clinician-level factors contribute to the decision to prescribe PPT after an index stone event. We identified Medicare beneficiaries with urinary stone disease who had a 24-hour urine collection processed by a central laboratory. Among the subset with a urine chemistry abnormality (ie, hypercalciuria, hypocitraturia, hyperuricosuria, or low urine pH), we determined whether PPT was prescribed within 6 months of their collection. After assigning patients to the clinicians who ordered their collection, we fit multilevel models to determine how much of the variation in PPT prescription was attributable to patient vs clinician factors. Of the 11,563 patients meeting inclusion criteria, 33.6% were prescribed PPT. There was nearly sevenfold variation between the treating clinician with the lowest prescription rate (11%) and the one with the highest (75%). Nineteen percent of this variation was attributable to clinician factors. After accounting for measured patient differences and clinician volume, patients had twice the odds of being prescribed PPT if they were treated by a nephrologist (odds ratio [OR], 2.15; 95% CI, 1.79-2.57) or a primary care physician (OR, 1.78; 95% CI, 1.22-2.58) compared to being treated by a urologist. These findings suggest that the type of clinician whom a patient sees for his stone care determines, to a large extent, whether PPT will be prescribed.

The Fruit and Veggies for Kidney Health Study: A Prospective Randomized Trial

Providing fruits and vegetables (F&Vs) to health care system patients with elevated urine albumin-creatinine ratio (ACR) reduced ACR, slowed chronic kidney disease (CKD) progression and reduced cardiovascular disease (CVD) risk factors in previous studies. This study evaluated a community-based strategy in lower-income populations to identify African Americans with elevated ACR before health care system involvement and sustain them in a 6-month F&V protocol with (F&V+Cook) and without (F&V Only) cooking instructions, with the hypothesis that adjuvant cooking instructions with F&Vs would further reduce ACR. Prospective, randomized, parallel 2-arm design. African American adults with ACR>10mg/g creatinine randomized to 1 of 2 study arms. Two cups/day of F&Vs with or without cooking instructions in participants followed 6 months. Participants sustaining the F&V protocol and between-group indicators of CVD risk, kidney injury, and dietary intake at 6 weeks and 6 months. A total of 142 African American adults (mean age, 57.0 years; ACR, 27.4mg/g; body mass index, 34.4; 24.9% CKD 1; 24.8% CKD 2; 50.4% CKD 3; 55% female) randomized to F&V Only (n=72) or F&V+Cook (n=70), and 71% were retained at 6 months. Participants received 90% of available F&V pick-ups over 6 weeks and 69% over 6 months. In the adjusted model, 6-month ACR was 31% lower for F&V+ Cook than F&V Only (P=0.02). Net 6-week F&V intake significantly increased and biometric variables improved for participants combined into a single group. Small sample size, low-baseline ACR, and potential nonresponse bias for 24-hour dietary recall measure. These data support the feasibility of identifying community-dwelling African Americans with ACR indicating elevated CVD and CKD risk and sustaining a F&V protocol shown to improve kidney outcomes and CVD risk factors and provides preliminary evidence that cooking instructions adjuvant to F&Vs are needed to lower ACR. National Institute on Diabetes, Digestive, and Kidney Diseases grant "Reducing chronic kidney disease burden in an underserved population" (R21DK113440). NCT03832166. African Americans, particularly those in low-income communities, have increased rates of chronic kidney disease (CKD) with worsening outcomes over time. Giving fruits and vegetables to individuals with CKD identified in health care systems was previously shown to reduce kidney damage, measured by urine protein albumin, and slow kidney function decline. We recruited African Americans in low-income communities with increased urine albumin levels. They received fruits and vegetables for 6 months, and we tested whether added cooking instructions further reduced urine albumin levels. Most participants continued to receive fruits and vegetables throughout the 6 months. Those given cooking instructions had lower urine albumin levels after 6 months, indicating decreased kidney damage. Providing cooking instructions with fruits and vegetables appears to lessen kidney damage more than just fruits and vegetables alone.

Head-to-Head Comparison of 68Ga-PSMA-11 with 68Ga-P137 in Patients with Suspected Prostate Cancer.

P137 is a novel oxalyldiaminopropionic acid-urea-based prostate-specific membrane antigen (PSMA) targeting agent. This study compared the uptake patterns of 68Ga-P137 and the FDA-approved PET tracer 68Ga-PSMA-11 for diagnosing prostate cancer (PCa). Sixteen patients suspected of PCa were scanned by 68Ga-PSMA-11 and 68Ga-P137 PET/CT, respectively, followed by prospective analysis. The tumor-to-background ratio was calculated using normal prostate tissue, blood pool, muscle, and urine as backgrounds. Pathology or follow-up results were used to analyze uptake patterns of benign/malignant lesions and various organs. Thirteen patients were diagnosed with PCa and three with benign prostate diseases (BPD). The number and location of primary lesions, lymph node metastasis (LNM) (n = 25), bone metastasis (n = 30), and liver metastasis (n = 3) detected by the two tracers were identical. Maximum standardized uptake value (SUVmax), tumor/normal prostate ratio, as well as semiquantitative miPSMA-ES and PRIMARY diagnostic scores (P all >0.05) showed similar uptake levels of primary lesions between 68Ga-P137 and 68Ga-PSMA-11. Compared to 68Ga-P137, the SUVmax of 68Ga-PSMA-11 was significantly higher for bone metastasis, LNM, and liver metastasis (14.9 ± 7.2 vs 9.1 ± 4.4, 14.4 ± 5.0 vs 7.5 ± 2.4, 13.9 ± 2.0 vs 8.8 ± 2.4, P all <0.05). One-hour postinjection, SUVmax of the duodenum (9.4 ± 2.1 vs 16.2 ± 6.1), kidney (19.4 ± 4.3 vs 45.6 ± 20.9), and urine (14.1 ± 7.1 vs 42.1 ± 25.9) were significantly lower for 68Ga-P137 than for 68Ga-PSMA-11 (P all <0.05), whereas the radioactivity accumulation of blood pool and muscle (3.9 ± 0.5 vs 1.6 ± 0.4, 1.0 ± 0.1 vs 0.6 ± 0.1, P all <0.05) of 68Ga-P137 was significantly higher than 68Ga-PSMA-11. The uptake level of 68Ga-P137 has no significant difference from that of 68Ga-PSMA-11 in prostate primary lesions, and their imaging performances are visually equivalent for both primary and metastatic lesions, despite a higher blood pool and muscle background and a lower uptake in metastatic lesions. Due to the lower urine excretion of 68Ga-P137, primary prostate lesions near the urine can potentially be displayed clearer than 68Ga-PSMA-11.

The relationship between commencement of continuous renal replacement therapy and urine output, fluid balance, mean arterial pressure and vasopressor dose

Background and objectives: The effect of initiating continuous renal replacement therapy (CRRT) on urine output, fluid balance and mean arterial pressure (MAP) in adult intensive care unit (ICU) patients is unclear. We aimed to evaluate the impact of CRRT on urine output, MAP, vasopressor requirements and fluid balance, and to identify factors affecting urine output during CRRT. Design: Retrospective cohort study using data from existing databases and CRRT machines. Setting: Medical and surgical ICUs at a single university-associated centre. Participants: Patients undergoing CRRT between 2015 and 2018. Main outcome measures: Hourly urine output, fluid balance, MAP and vasopressor dose 24 hours before and after CRRT commencement. Missing values were estimated via Kaplan smoothing univariate time-series imputation. Mixed linear modelling was performed with noradrenaline equivalent dose and urine output as outcomes. Results: In 215 patients, CRRT initiation was associated with a reduction in urine output. Multivariate analysis confirmed an immediate urine output decrease (-0.092 mL/kg/h; 95% confidence interval [CI], -0.150 to -0.034 mL/kg/h) and subsequent progressive urine output decline (effect estimate, -0.01 mL/kg/h; 95% CI, -0.02 to -0.01 mL/kg/h). Age and greater vasopressor dose were associated with lower post-CRRT urine output. Higher MAP and lower rates of net ultrafiltration were associated with higher post-CRRT urine output. With MAP unchanged, vasopressor dose increased in the 24 hours before CRRT, then plateaued and declined in the 24 hours thereafter (effect estimate, -0.004 μg/kg/ min per hour; 95% CI, -0.005 to -0.004 μg/kg/min per hour). Fluid balance remained positive but declined towards neutrality following CRRT implementation. Conclusions: CRRT was associated with decreased urine output despite a gradual decline in vasopressor and a positive fluid balance. The mechanisms behind the reduction in urine output associated with commencement of CRRT requires further investigation.

Prevalence Of Metabolic Disorders In Paediatric Age Group with Renal Stone Diseases.

Background: inflammation of the urinary tract and prostatic disease is urolithiasis. The causes are numerous , with metabolic diseases , individual life style and environmental factors all playing a part. In pediatric populations , the prevalence of nephrolithiasis is very low; however, some evidence suggests that children are increasingly likely to get this disease. Kidney stone diseases are becoming more frequent among young people, and although the absolute figure remains smaller than in adults , this complex situation however it is should be stressed that factor consists of metabolic disorders such as hypocitraturia, hypercalciuria, and hyperoxaluria. The process of stone production is subject to several factors , for example genetic predisposition , familial background and dietary habits. A commonly employed approach in the prompt identification and treatment of kidney stones involves implementing a comprehensive strategy that tackles both the stones themselves as well as their underlying metabolic problems. It is still necessary to keep on doing research in the area of Pediatric Urology. Only by continuing to do this work will our understanding be deepened and our treatment methods refined in the dynamic world of modern medical science. Objectives: To find out the prevalence of metabolic abnormalities in young children with urolithiasis . Study design: A Retrospective Study Place and duration of the study : Department Of Urology Main Gul Jehanzeb Hospital Swat In Pakistan From January 2018 To January 2019. Methods: From April 2018 to August 2019, the Department Of Urology Main Gul Jehanzeb Hospital Swat carried out a retrospective study. The retrospective study was aimed at analyzing the medical records of 59 patients under the age of 15-year-old with renal stone disease living in this region. Basic details such as age, sex, body mass index (BMI),creatinine levels, serum calcium, serum phosphate, serum uric acid levels, 24-hour urine volume, urinary sodium potassium and chloride content were all obtained and analyzed carefully. The identifications of metabolic diseases were carried out according to recognized laboratory standards. Data processing was performed using SPSS version 22. Results: A total of fifty-nine people ranging from age 8 to 15 years old underwent this study. Of these 25 (42.4%) were female and 34 (57.6%) were male. The mean BMI which the patients exhibited was 16.68 kg/m2. However according to the investigation results, 32 patients (54.2%) had metabolic abnormalities associated with renal stone disease. Hyperuricemia (22%), hypercalciuria (25.4%) and hypokalemia (40.7%) were the three most common diseases identified. Hyperphosphaturia (1.7%), hypocitraturia (1.7%), hyperoxaluria (3%), low urine volume (6.8%) were also found among other types of metabolic abnormalities discovered. Conclusion: According to this study, a large number of children (54.2%) with stone disease in the kidney also had associated metabolic disorders. Hypokalemia was the most common metabolic abnormality in children (40.7%), followed by hypercalciuria (25.4%) and hyperuricemia (22%). These results suggest that children with stone disease in the kidney should be carefully examined for metabolic defects. Primary and secondary prevention methods must be explored in future in order to reduce the occurrence of these problems. Keywords: children with metabolic disorders, kidney stones, hypercalciuria, hypokalemia, and hyperuricemia are frequently seen

The Effect of Variation in Dietary Cation-Anion Difference on Calcium Status, Blood Metabolites and Rumen Activity during the Transition Period of Holstein Dairy Cows

A negative dietary cation-anion difference (DCAD) induces a compensated metabolic acidosis, stimulating calcium (Ca) absorption and mobilization before calving, thereby decreasing clinical and subclinical hypocalcemia postpartum. The study was designed to determine the effects of varying pre- and postpartum DCAD diets on serum total calcium, ionized calcium, blood and ruminal fluid metabolites, and milk production in prepartum and postpartum Holstein cows. Fifty-four multiparous dry Holstein cows n= 54, were enrolled in a completely randomized block experimental design at 29 days prior to expected parturition through 86 days in milk. A 3 x 2 factorial arrangement of treatments was utilized. Three DCAD levels were fed precalving (0, -120 and -200 mEq/kg DM), n=18 cows per treatment and two DCAD levels were fed post calving (+200 and +400 mEq/kg DM), n=27 cows per treatment. Prepartum urine pH was lower for cows fed -200 DCAD compared with those fed -120 or 0 DCAD. Postpartum urine pH was higher for cows fed +400 mEq/kg compared to cows fed +200 mEq/kg DCAD. Prepartum serum total calcium, ionized calcium, and hydroxyproline was highest for cows fed -200 DCAD compared to those fed -120 and 0 DCAD. Parathyroid hormone was highest for cows fed 0 DCAD compared to those fed -120 and -200 DCAD. Prepartum dry matter intake (DMI) was lower for -200 and -120 DCAD compared with 0 DCAD. Postpartum DMI was not different among treatments. Pre- and postpartum DCAD treatments did not affect total milk yield or milk fat, percentage of milk protein not affected by different pre-and postpartum DCAD levels. Prepartum anionic diets lowered urine pH and parathyroid hormone and raised serum hydroxyproline, resulting in improved Ca availability after parturition. Postpartum blood metabolites were unaffected in cows given positive DCAD (+200 and +400 mEq/kg DM). Calves born to cows fed low DCAD had no change in calf bieth weight. Colostrum amount and IgG concentrations were unaffected by treatments. No effects of pre-or postpartum DCAD treatments were observed for milk yield and fat-corrected milk. Feeding prepartum an acidogenic diet improved postpartum Ca status in multiparous Holstein cows.

A comparison with micro albuminuria indicates whether urine and serum kidney injury molecule-1 can predict the onset of early diabetic nephropathy (DN).

Diabetic nephropathy (DN) is the most frequent consequence of DM and a significant contributor to chronic kidney disease, a multifactorial illness. Kidney injury molecule-1 (KIM-1) is a sensitive and accurate indicator of kidney damage and a predictive indicator. Aim: The present investigation aimed to examine serum and urine KIM-1 as a DN early marker. Patients and methods: The present study included 150 participants, among whom 50 non-diabetic participants were chosen as controls. One hundred diabetic participants were split into two groups based on their urine albumin/creatinine ratio (ACR) as participants with normoalbuminuria (T2DM patients without nephropathy) and microalbuminuria (T2DM patients with nephropathy). The blood glucose, HbA1c, s.urea, and creatinine levels in serum and urine were measured using standard laboratory techniques, and Elisa Essay measured serum and urine KIM-1 levels. Results: There was a distinct variation in the mean serum and urine KIM-1 between the control and diabetics without microalbuminuria (P = 0.001). Serum KIM-1 correlated with ACR (P = 0.669) in people with diabetes with microalbuminuria. Urine KIM-1 was less correlated than serum KIM-1 (p = 0.257). A strong association was found between ACR and serum KIM1 in people with diabetes with microalbuminuria and a low correlation between ACR and urine KIM-1 in people with diabetes with microalbumin. Conclusion: According to the current investigation, diabetic groups with microalbuminuria had higher serum and urine levels of KIM-1 than the control groups. Additionally, there was a favorable correlation between serum KIM-1 and the length of diabetes. More extensive multicentric trials are also needed to assess the efficacy of serum and urine KIM-1 as a DN early marker. Keywords: Serum /Urine KIM-1; Dibetic nephropathy; Microalbumin; DM type2