Marker Of Renal Impairment Research Articles

Fibroblast Growth Factor23 as a Novel Marker of Renal Impairment in Multiple Myeloma

Fibroblast Growth Factor23 as a Novel Marker of Renal Impairment in Multiple Myeloma

Transgelin-2 in Multiple Myeloma: A New Marker of Renal Impairment?

Transgelin is a 22-kDa protein involved in cytoskeletal organization and expressed in smooth muscle tissue. According to animal studies, it is a potential mediator of kidney injury and fibrosis, and moreover, its role in tumorigenesis is emerging in a variety of cancers. The study included 126 ambulatory patients with multiple myeloma (MM). Serum transgelin-2 concentrations were measured by enzyme-linked immunoassay. We evaluated associations between baseline transgelin and kidney function (serum creatinine, estimated glomerular filtration rate—eGFR, urinary markers of tubular injury: cystatin-C, neutrophil gelatinase associated lipocalin—NGAL monomer, cell cycle arrest biomarkers IGFBP-7 and TIMP-2) and markers of MM burden. Baseline serum transgelin was also evaluated as a predictor of kidney function after a follow-up of 27 months from the start of the study. Significant correlations were detected between serum transgelin-2 and serum creatinine (R = 0.29; p = 0.001) and eGFR (R = −0.25; p = 0.007). Transgelin significantly correlated with serum free light chains lambda (R = 0.18; p = 0.047) and serum periostin (R = −0.22; p = 0.013), after exclusion of smoldering MM patients. Patients with decreasing eGFR had higher transgelin levels (median 106.6 versus 83.9 ng/mL), although the difference was marginally significant (p = 0.05). However, baseline transgelin positively correlated with serum creatinine after the follow-up period (R = 0.37; p < 0.001) and negatively correlated with eGFR after the follow-up period (R = −0.33; p < 0.001). Moreover, higher baseline serum transgelin (beta = −0.11 ± 0.05; p = 0.032) significantly predicted lower eGFR values after the follow-up period, irrespective of baseline eGFR and follow-up duration. Our study shows for the first time that elevated serum transgelin is negatively associated with glomerular filtration in MM and predicts a decline in renal function over long-term follow-up.

A Comparative Study of Serum Cystatin C, Serum Electrolytes, Urea and Creatinine in Early Detection of Kidney Injuries in Albino Rats Exposed to Formaldehyde

Aim: To ascertain early detection of possible kidney injuries in albino rats exposed to formaldehyde by assessing cystatin C, serum electrolytes, urea and creatinine. Materials/Methods: Thirty healthy adult male albino rats, weighing between 100 to 120 grams were randomly divided into three groups A, B and C. Group A served as control. Group B was exposed to low dose (100ppm of Formaldehyde), 3 hrs per day for four weeks, while group C was exposed to high Dose-200ppm of formaldehyde 3 hrs per day for four weeks. At the end of the exposure period, the rats were sacrificed by decapitation under chloroform anesthesia, and 4 ml of blood samples was collected from each rat into a plain bottle. The whole blood was allowed to clot, retracted and centrifuged at 3000 rpm for 10 minutes and serum separated. The serum was stored at -20˚C until analyses for serum electrolytes, creatinine and cystatin C. Serum electrolytes were determined using Ion selective electrode, urea and creatinine were determined using spectrophotometric methods while cystatin C was analyzed using Eliza. Data obtained was analyzed using SPSS. Results: The concentrations of the serum electrolytes, sodium. Potassium, bicarbonate and chloride were compared across the three group, they were not statistically significant (p&gt;0.05). Urea was significantly higher in group C when compared with low dose B and control group A (P&lt;0.05). Also, when the low dose group B was compared with the high dose group C, it was statistically significant. Creatinine concentrations were significantly higher in group C when compared with the control group A, while group B was not significant when compared with group A. Finally, the cystatin C concentrations were also significant when groups B, C were compared with the control group. Conclusion: Formaldehyde exposures may induce a gradual deterioration of renal functions in chronically exposed albino rats. Serum electrolytes, urea and creatinine may not be sufficient to indicate an early signs of kidney damage. From the study, serum cystatin C may be a better marker of renal impairment in early stages.

Renal Function, Albumin-Creatinine Ratio and Pulse Wave Velocity Predict Silent Coronary Artery Disease and Renal Outcome in Type 2 Diabetic and Prediabetic Subjects.

Silent coronary heart disease is frequently undetected in type 2 diabetes mellitus (DM2) and pre-diabetes determined by glucose intolerance (GI). Pulse wave velocity (PWV) and albumin-creatinine ratio (ACR) have been considered markers of cardiovascular mortality, coronary heart disease and chronic renal failure. To evaluate the incidence of coronary artery disease (CAD) and the relationship between urinary albumin-creatinine ratio, glomerular filtration rate (GFR) and PWV in type 2 DM with silent CAD. We analyzed 92 individuals (44 male), 49 (60±7y) type 2 DM non-insulin dependents and 43 prediabetics (43±4y), with Grade I-II hypertension and no symptoms of CAD. All type 2 DM patients were under antidiabetic treatment with A1C hemoglobin between 5.5 and 6.5%. Every patient underwent a myocardial perfusion SPECT scan. In those subjects with ischemic patterns, coronary angiography was performed. In addition, PWV, glomerular filtration rate, and ACR were evaluated. mean±SEM, and ANOVA among groups. 48.59% of DM2 and 25.58% of GI patients had silent coronary artery had silent coronary artery disease and higher ACR, PWV and reduced GFR. Higher ACR and PWV and reduced GFR. DM2 and GI showed a negative relationship between GFR and ACR. Moreover, this relation was also observed in different levels of GFR (>60 ml/min and <60ml.min (p<0.05) in patients with CAD, suggesting a cardio-renal interaction in DM2. Higher PWV, lower GFR and ACR predict the incidence of CAD in DM2. Dysglycemic individuals also represent a group of higher risk for coronary artery disease with similar predictors as in DM2. Diabetic and prediabetics still develop renal microalbuminuria. Thus, PWV seems to represent a reliable marker of renal impairment and coronary artery disease.

Dynamic Changes in Neutrophils Anti-Apoptic Chemokines and Cytokines Influence the Outcome of COVID-19 in Sudanese Patients

Background: SARS-CoV-2 virus is causing a global pandemic that has so far affected more than 179 million individuals with more than 3.8 million deaths. COVID-19 is an acute respiratory syndrome presented by respiratory and hematological dysfunctions with evidence of multiorgan pathology. Studies have shown that COVID-19 is marked by neutrophilia, lymphopenia, thrombocytopenia and induction of intense chemokine/ cytokine response causing cytokine storm. IL-6, IL-8 and IL-10 have been identified as biomarkers of severe COVID-19.This manuscript aimed to analyze the dynamic changes of the neutrophil and chemokine/ cytokine response in relation to outcome of COVID-19 in Sudanese COVID-19 patients. Methods: Thirty three (33) confirmed COVID-19 patients and 8 contact controls were enrolled in this study. Fifteen patients were males. The age of the patients ranged between 23 and 86 years with mean age of 54.5, while 4 males and 4 females were enrolled as control with age range 32- 44 years. The patients were admitted as moderate or severe COVID-19 cases. Clinical and laboratory investigations were done for all participants. Twenty chemokines/ cytokines were measured in plasma samples collected at the day of admission and day 12 post-admission using microarray. The patients were followed for 4 weeks the duration of the hospitalization and were categorized into three groups according to the outcome of the management: recovered, died or developed renal complications. The data was analyzed to determine the dynamic of the changes of neutrophils and chemokine/ cytokines in relation to the outcome of the disease. Findings: The most frequent clinical signs were fever, cough, headache, fatigue, loss of taste and/ or smell. COVID-19 was confirmed by RT PCR, X-ray of Ct scan of the lungs. The hematology investigations showed neutrophilia, lymphopenia, thrombocytopenia, disturbed liver and renal functions. The neutrophil/ lymphocyte ratio was elevated. Analysis of the first samples showed the production of both pro and anti-inflammatory chemokines/cytokines. IL-6, IL-8 and IL-10 were elevated compared with the contact controls and were identified as biomarkers for COVID-19. During the follow up: 18 patients recovered, 11 died and 4 developed renal failure and required dialysis. Analysis of the samples collected at Day 12 showed dynamic changes in neutrophil count, neutrophil: lymphocyte ration, and the chemokine/ cytokine levels compared with the first samples. There was a minor decrease in neutrophil/ lymphocyte ratio specially among patients who died. There was a significant elevation of neutrophil anti-apoptic chemokines/ cytokines specially among patients who died. IL-6, IL-8 and IL-10 were markers of fatal outcome of CPOVID-19 patients, while IL-1β, IL-4 and TNFα were markers of renal impairment. Interpretation: COVID-19 is marked by elevations of neutrophil, proinflammatory chemokines/ cytokines and elevation of neutrophil anti-apoptic mediators. The data suggest a significant role of neutrophil in the severity and the outcome of CPVID-19. Elevated IL-6, IL-8 and IL-10 were biomarkers of severe and fatal outcome of COVID-19 while elevated IL-1β, IL-4 and TNFα were biomarkers of renal impairment in moderate and severe COVIUD-19 patients . Funding Information: This research was commissioned by the National institute for Health Research (NIHR) Global Health Research Programme (16/136/33) using UK AID from the UK Government. Declaration of Interests: All authors declare no competing interest in the conducted study. Ethics Approval Statement: This study received ethical approval from Khartoum State Ministry of health ethics committee. Written consents were obtained from the participants before their enrollment in the study.

Associations with sight-threatening diabetic macular oedema among Indigenous adults with type 2 diabetes attending an Indigenous primary care clinic in remote Australia: a Centre of Research Excellence in Diabetic Retinopathy and Telehealth Eye and Associated Medical Services Network study

ObjectiveTo identify factors associated with sight-threatening diabetic macular oedema (STDM) in Indigenous Australians attending an Indigenous primary care clinic in remote Australia.Methods and analysisA cross-sectional study design of retinopathy screening...

Clinical laboratory tests and five-year incidence of major depressive disorder: a prospective cohort study of 433,890 participants from the UK Biobank

Prevention of major depressive disorder (MDD) is a public health priority. Identifying biomarkers of underlying biological processes that contribute to MDD onset may help address this public health need. This prospective cohort study encompassed 383,131 white British participants from the UK Biobank with no prior history of MDD, with replication in 50,759 participants of other ancestries. Leveraging linked inpatient and primary care records, we computed adjusted odds ratios for 5-year MDD incidence among individuals with values below or above the 95% confidence interval (<2.5th or >97.5th percentile) on each of 57 laboratory measures. Sensitivity analyses were performed across multiple percentile thresholds and in comparison to established reference ranges. We found that indicators of liver dysfunction were associated with increased 5-year MDD incidence (even after correction for alcohol use and body mass index): elevated alanine aminotransferase (AOR = 1.35, 95% confidence interval [1.16, 1.58]), aspartate aminotransferase (AOR = 1.39 [1.19, 1.62]), and gamma glutamyltransferase (AOR = 1.52 [1.31, 1.76]) as well as low albumin (AOR = 1.28 [1.09, 1.50]). Similar observations were made with respect to endocrine dysregulation, specifically low insulin-like growth factor 1 (AOR = 1.34 [1.16, 1.55]), low testosterone among males (AOR = 1.60 [1.27, 2.00]), and elevated glycated hemoglobin (HbA1C; AOR = 1.23 [1.05, 1.43]). Markers of renal impairment (i.e. elevated cystatin C, phosphate, and urea) and indicators of anemia and macrocytosis (i.e. red blood cell enlargement) were also associated with MDD incidence. While some immune markers, like elevated white blood cell and neutrophil count, were associated with MDD (AOR = 1.23 [1.07, 1.42]), others, like elevated C-reactive protein, were not (AOR = 1.04 [0.89, 1.22]). The 30 significant associations validated as a group in the multi-ancestry replication cohort (Wilcoxon p = 0.0005), with a median AOR of 1.235. Importantly, all 30 significant associations with extreme laboratory test results were directionally consistent with an increased MDD risk. In sum, markers of liver and kidney dysfunction, growth hormone and testosterone deficiency, innate immunity, anemia, macrocytosis, and insulin resistance were associated with MDD incidence in a large community-based cohort. Our results support a contributory role of diverse biological processes to MDD onset.

Tumor Necrosis Factor-Like Weak Inducer of Apoptosis and Selected Cytokines—Potential Biomarkers in Children with Solitary Functioning Kidney

This study was performed to explore serum tumor necrosis factor-like weak inducer of apoptosis (TWEAK) and its dependent cytokines urinary excretion: monocyte chemoattractant protein-1 (MCP-1) and regulated on activation, normal T cell expressed and secreted chemokine (RANTES) with their relation to the kidney function parameters in children with solitary functioning kidney (SFK). The study included 80 children and adolescents (median age 9.75 year) with congenital and acquired (after surgical removal) SFK. Serum TWEAK and urinary MCP-1 and RANTES levels were significantly higher in SFK patients (p < 0.05). The serum TWEAK was positively related to serum creatinine (r = 0.356; p < 0.001). Moreover, in SFK the receiver operating characteristic analyses revealed good diagnostic profile for serum TWEAK with AUC (Area Under The Curve)—0.853, uRANTES—0.757, and for RANTES/cr.: AUC—0.816. Analysis carried out to identify children with impaired renal function (albuminuria and/or decreased estimated glomerular filtration rate < 90 mL/min/1.73 m2 and/or hypertension) showed good profile for TWEAK (AUC—0.79) and quite good profile for uRANTES and RANTES/cr. (AUC 0.66 and 0.631, respectively). This is the first study investigating serum TWEAK and urinary excretion of MCP-1 and RANTES together in children with SFK. Obtained results indicate that TWEAK and RANTES may serve as potential markers of renal impairment.

Complement Properdin Determines Disease Activity in MRL/lpr Mice.

Background and objects: In systemic lupus erythematosus, circulating immune complexes activate complement and, when trapped in renal capillaries, cause glomerulonephritis. Mouse models have been used in the preclinical assessment of targeting complement activation pathways to manage chronic inflammation in lupus. Properdin is the only known positive regulator of complement activation, but its role in the severity of lupus nephritis has not been studied yet. Materials and Methods: Fully characterized properdin-deficient mice were crossed with lupus prone MRL/lpr mice on C57Bl/6 background. Results: Compared to MRL/lpr properdin wildtype mice, MRL/lpr properdin-deficient mice had significantly lower anti-DNA antibody titres, TNFα and BAFF levels in serum. The qualitative glomerulonephritic score was less severe and there was significantly less serum creatinine in MRL/lpr properdin-deficient mice compared to MRL/lpr properdin wildtype littermate mice. Conclusion: Properdin plays a significant role in the severity of lupus overall and specifically in the extent of glomerulonephritis observed in MRL/lpr mice. Because MRL/lpr properdin-deficient mice had lower levels of anti-DNA antibodies, inflammatory mediators and markers of renal impairment, the study implies that properdin could constitute a novel therapy target in lupus disease.

Epidemiologic and clinical characteristics of 42 deaths caused by SARS-CoV-2 infection in Wuhan, China: A retrospective study

This study described the epidemiologic and clinical characteristics of patients who died from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and pointed out the potential risk factors associated with fatal outcomes. Retrospective data from 42 death cases due to SARS-CoV-2 infection at Tongji Hospital Affiliated to Huazhong University of Science and Technology, Wuhan, China was analyzed. Demographics, clinical detection, laboratory findings, and treatments of the deceased were collected and analyzed. The average time between onset of symptoms and admission to the hospitals was 11 ± 5 days of hospitalization. Among the deceased, 60% were with co-morbidities. All of them were having fever and bilateral pneumonia on computed tomography, abnormal infection-related biomarkers, and renal impairment. Abnormal blood coagulation parameters that appeared in more than half of them, were consistent with disseminated intravascular coagulation. All of the patients were treated in the ICU. Based on the fact that SARS-CoV-2 infection carries a risk of mortality, we may infer a few older male patients with underlying comorbidities are likely to have the increased risk. Impaired consciousness level, markers of renal impairment and coagulation abnormalities may be poor prognostic factors.

Sonographically determined kidney measurements are better able to predict histological changes and a low CKD-EPI eGFR when weighted towards cortical echogenicity

BackgroundThe renal length and cortical echogenicity have shown correlation to the renal function and histological changes in CKD patients. The aim of this study was to assess the accuracy of crude and composite ultrasound parameters based on kidney measurements and cortical echogenicity to detect renal dysfunction and histological changes.MethodsKidney sonography and biopsy were performed in 112 patients. Histological changes were graded in 0, < 25%, ≥25%, ≤50 and > 50% of the sample. Cortical echogenicity was graded relative to liver or spleen parenchyma: less than, equal to and higher than the liver/spleen. Kidney length, the kidney length/body height ratio (KL/H) and cortical thickness were obtained. Each parameter was multiplied by a cortical echogenicity-weighting arbitrary factor: 1.17, 1 or 0.69 for cortex less than, equal to or higher than the liver, respectively. The GFR was estimated using the CKD-EPI formula. The accuracy of crude and composite parameters to identify patients with a high creatinine, a low GFR and histological changes were evaluated.ResultsThe discriminative power of kidney length and cortical thickness for renal dysfunction and histological changes was improved after weighting for cortical echogenicity. However, the best discriminative was the kidney length to height ratio weighted towards renal echogenicity (w-KL/H).Conclusionw-KL/H exceeded the other parameters as a marker of renal impairment and histological changes in CKD. Calculation of the w-KL/H index may be of help as a non-invasive tool to identify patients with significant renal disease and might be useful to guide therapeutic decisions.

Serum Ceramides Level in Systemic Lupus Erythematosus (SLE) Patients as a Novel Marker for Renal Impairment

Serum Ceramides Level in Systemic Lupus Erythematosus (SLE) Patients as a Novel Marker for Renal Impairment

Epidemiologic and Clinical Characteristics of 42&amp;nbsp;Deaths Due to SARS-CoV-2&amp;nbsp;Infection in Wuhan, China:&amp;nbsp;A Retrospective Study

Background: In December 2019, 2019-nCoV appeared in Wuhan, China. Some of these cases led to death. Here, we describe the epidemiologic and clinical characteristics of patients who died from SARS-CoV-2 infection, and the potential risk factors associated with a fatal outcome. Methods: This retrospective case analyzed data from 42 death cases due to 2019-nCoV infection at Tongji Hospital Affiliated to Huazhong University of Science and Technology, Wuhan, China, including demographics, clinical detection, laboratory findings, and treatments. Findings: The mean time to admission from symptom onset was11±5 days, the mean hospital stay was 5±4 days. Among the 42 patients, 71% were male, 60% had ≥1 co-morbidity. All patients had fever and bilateral pneumonia on computed tomography, abnormal nfection-related biomarkers, and renal impairment. Abnormal blood coagulation parameters seen in more than half of patients may be consistent with disseminated intravascular coagulation. All these patients were treated in the ICU. Interpretation: SARS-CoV-2 infection carries a risk of mortality; based on this case series older men with underlying co-morbidities are likely at increased risk. Impaired consciousness level, markers of renal impairment and coagulation abnormalities may be poor prognostic factors. Funding Statement: This work was supported by grants from the Epidemiology, Early Warning, and Response Techniques of Major Infectious Diseases in the Belt and Road Initiative (#2018ZX10101002), National Natural Science Foundation of China (#81871699), and Foundation of Jilin Province Science and Technology Department (#172408GH010234983). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Tongji Hospital Affiliated to Huazhong University of Science and Technology, in Wuhan, Hubei Province, China, approved this retrospective study. Ethical approval was granted by the Ethics Commission of Tongji Hospital Affiliated to Huazhong University of Science and Technology.

Feasibility of Using Fusion Techniques in the Follow Up of Complex Aneurysm Repair

Introduction - Fusion imaging is becoming standard for the endovascular treatment of complex aortic aneurysms, but its role in follow up has not been explored. A critical issue in post operative surveillance is renal functional deterioration over time. Renal volume, stent angulation and stenosis have all been used as a marker of renal impairment (1)(2), however combined assessment of these variables is not always reproducible and remains a complex and resource-intensive procedure. The aim of this study is to determine the accuracy of a fusion-based software to automatically calculate the renal volume changes during follow-up (FU) and standardise its use.

Is concentration of uric acid in hemodialysis patients associated with level of other markers of renal impairment and cardiovascular complications?

Is concentration of uric acid in hemodialysis patients associated with level of other markers of renal impairment and cardiovascular complications?

Correlations between related-purine derivatives and renal disorders in patients with psoriasis vulgaris.

Recent data suggest that severe psoriasis is an independent risk factor for chronic renal disease. In the present study, we investigated the role of related-purine derivatives as predictors of renal dysfunctions in patients with psoriasis. A prospective study was conducted on a group of 45 patients with psoriasis vulgaris and 45 control cases, monitored over a 5-year period. Alterations of renal function, albumin/creatinine ratio (ACR, mg/g) and UA/creatinine ratio (UACR, mg/mg) were determined in spontaneous urine samples. The status of related-purine derivatives was evaluated by quantification of uric acid (UA, mg/dl), adenosine deaminase (ADA, UI/mg protein), xanthine oxidase (XO, UI/mg protein) and 8-hydroxy-deoxy-guanosine levels (8-OHdG, ng/ml) in serum samples. Compared to the controls, in patients with psoriasis there was an increase in related-purine derivatives levels, which was demonstrated by the elevated serum levels of UA (5.1±0.4 vs. 5.4±1.0, P=0.066), ADA (0.14±0.08 vs. 0.29±0.12, P=0.052), XO (0.22±0.11 vs. 0.42±0.21, P=0.011) and 8-OHdG (3.1±0.05 vs. 8.3±4.7, P=0.002). The serum levels of related-purine derivatives were associated with the severity of psoriasis. In addition, there was a link between the serum levels of related-purine derivatives and markers of renal impairment. There were positive correlations between 8-OHdG and ACR (r=0.452, P=0.028) and between ADA, XO, UA, 8-OHdG and UACR (r=0.297 and P=0.032, r=0.301 and P=0.002, r=0.431 and P=0.027, r=0.508 and P=0.002) and negative correlations between UA, 8-OHdG and the estimated glomerular filtration rate (r=-0.301 and P=0.036, r=-0.384 and P=0.002). Thus, severe psoriasis is a risk factor for the development of renal disease.

A16827 Effects of embryo-fœtal exposure to alcoholic beverages following maternal consumption, on markers of renal impairment in adult offspring

A16827 Effects of embryo-fœtal exposure to alcoholic beverages following maternal consumption, on markers of renal impairment in adult offspring

A11592 Ankle-brachial index as a marker of renal impairment in patients with arterial hypertension and type 2 diabetes mellitus

Objectives: Diabetic nephropathy is a strong risk factor for cardiovascular disease (CVD) and early mortality. Ankle-brachial index (ABI) is a marker of generalized atherosclerosis associated with an increased risk of CVD. Aim of the study was to evaluate associations between kidney function and ABI in patients with AH and T2DM. Methods: 90 patients with AH and T2DM without known CVD were included (39% males, mean age 63,8 ± 11,6 years,44% smokers, 80%with dyslipidemia). Mean office BP was 146 ± 23/86 ± 10 mmHg. Target BP < 140/85 mm Hg was achieved in 52,7% patients. Median duration of DM was 8,5 years. Mean creatinine was 96 ± 21 μmol/l, mean eGFRCKD EPI-64 ± 19 ml/min/1,73m2. eGFR decrease < 60 ml/min/1,73m2 (renal impairment (RI) group) was observed in 43,3% of patients. BP was measured with a validated oscillometric device. ABI was measured by VaSera 1500. ABI < 0,9 was considered as a marker of subclinical atherosclerosis. Results were considered significant in p < 0,05. Results: Mean R-ABI was 1,02 ± 0,17,ABI decrease < 0,9 was observed in 20,2% patients in the whole group and in 30,7% patients in the RI group. Patients from RI group had higher age (69,7 ± 10vs59,2 ± 10,8 years), median duration of DM (10vs6,8, years) and lower right ABI (0,97 ± 0,21vs1,06 ± 0,12),p < 0,05 for trend. Patients with ABI decrease < 0,9 had significantly lower eGFR (53 ± 19vs68 ± 17 ml/min/1,73m2 respectively, p < 0,05).Spearmen analysis revealed significant correlations between eGFR and duration of DM (r = −0,3),R-ABI (r = 0,26), p < 0,05 for trend. Multiple regression analysis showed that eGFR was a significant predictor of ABI decrease (β = 0,35, p = 0,007). Conclusion: Renal impairment is a significant predictor of subclinical atherosclerosis in patients with AH and T2DM. This highlights the importance of clinical screening of PAD in this patient category

A comparative review of use of sulphate and phosphate salts for colonoscopy preparations and their potential for nephrotoxicity.

Background and study aims Colonoscopy is a widely used diagnostic procedure which requires prior cleansing of the bowel. Many different bowel cleansing preparations have been developed, all of which have specific advantages and disadvantages. This review compares two low-volume high-osmolarity bowel cleansing preparations, oral phosphate salts and oral sulphate salts, with a particular focus on risk of nephrotoxicity. Patients and methods An electronic search of the Medline database was performed using the search terms “(phosphates OR sulfates) AND cathartics [MeSH Term] AND kidney” restricted to humans with a cut-off date of December 31, 2016. Results Introduction of oral phosphate salts offered the advantage of low intake volume and low risk of bowel irritation compared to previous options. However, phosphate salts have been associated with renal toxicity (acute phosphate nephropathy [APN]), thought to arise due to perturbations of calcium and phosphate homeostasis as a consequence of increases in serum phosphate. This results in high concentrations of calcium phosphate in the distal tubule and collecting ducts of the kidney, where it may precipitate. Although APN is rare, it may lead to permanent kidney damage. For this reason, phosphate salts are contraindicated in vulnerable patient groups. As an alternative to phosphate salts, oral sulphate salts have recently been introduced. Because sulphate absorption from the intestinal tract is saturable, serum sulphate concentrations increase only minimally after ingestion. Furthermore, excretion of sulphate in the kidney is not accompanied by calcium excretion and urine calcium levels are unchanged. For these theoretical reasons, use of sulphate salts as bowel cleansing solutions is not expected to lead to calcium precipitation in the nephron. Conclusions Oral phosphate salts are no longer recommended for routine use as bowel cleansing preparations as they carry significant risk of kidney damage and a safer alternative is available in the form of oral sulphate solutions. To date, use of sulphate salts has not been associated with elevations in serum creatinine or other markers of renal impairment, nor with clinical manifestations of kidney injury. Nonetheless, experience with sulphate salts in everyday practice is limited and physicians should be vigilant in detecting potential safety issues.

Accuracy of implementing principles of fusion imaging in the follow up and surveillance of complex aneurysm repair.

Fusion imaging is standard for the endovascular treatment of complex aortic aneurysms, but its role in follow up has not been explored. A critical issue is renal function deterioration over time. Renal volume has been used as a marker of renal impairment; however, it is not reproducible and remains a complex and resource-intensive procedure. The aim of this study is to determine the accuracy of a fusion-based software to automatically calculate the renal volume changes during follow up. In this study, computerized tomography (CT) scans of 16 patients who underwent complex aortic endovascular repair were analysed. Preoperative, 1-month and 1-year follow-up CT scans have been analysed using a conventional approach of semi-automatic segmentation, and a second approach with automatic segmentation. For each kidney and at each time point the percentage of change in renal volume was calculated using both techniques. After review, volume assessment was feasible for all CT scans. For the left kidney, the intraclass correlation coefficient (ICC) was 0.794 and 0.877 at 1 month and 1 year, respectively. For the right side, the ICC was 0.817 at 1 month and 0.966 at 1 year. The automated technique reliably detected a decrease in renal volume for the eight patients with occluded renal arteries during follow up. This is the first report of a fusion-based algorithm to detect changes in renal volume during postoperative surveillance using an automated process. Using this technique, the standardized assessment of renal volume could be implemented with greater ease and reproducibility and serve as a warning of potential renal impairment.