Early Markers Of Renal Dysfunction Research Articles

Microalbuminuria in Children With Sickle Cell Disease in the Eastern Province of Saudi Arabia.

Sickle cell disease (SCD) complications, such as sickle cell nephropathy (SCN), may begin in childhood and progress insidiously to chronic kidney disease in adulthood. In Saudi Arabia (SA), there is a lack of studies evaluating kidney function in children with SCD. This study aims to assess microalbuminuria (MA) as an early marker of renal dysfunction in SCD children living in the Eastern region of SA, to potentially institute appropriate early treatment. A prospective cross-sectional study was conducted on 114 Saudi children with SCD under the age of 14 years who attended the pediatric hematology clinic for routine follow-up. Demographic and clinical information were collected from the patients and their parents, who provided informed consent. Morning urine samples were collected and tested for the presence of MA using the urinary albumin/creatinine ratio (ACR). Blood samples were also collected for basic laboratory investigations. The prevalence of MA and its correlation with various clinical and laboratory data were analyzed. Additionally, a comparison of clinical characteristics and MA was conducted between children originating from the Southwestern (SW) and Eastern regions of the country, all of whom lived in the Eastern Province. A total of 114 children with SCD were included in the study. The mean age was 8.8 ± 3.2 years, with a male-to-female ratio of 1.3:1. Based on their region of origin, they were divided into two groups: Eastern (n = 26/114) and SW (n = 88/114). MA was detected in 28 patients (24.6%), with no significant difference in prevalence between the two groups. There was no significant statistical difference in clinical and laboratory data between the groups, except for hemoglobin F (HBF) levels and the use of hydroxyurea (HU). HBF levels were significantly higher in children from the Eastern region, while more SW patients used HU. No correlation was found between MA and any of the studied variables. MA is common in children with SCD in the Eastern region of SA, with no difference in its prevalence between children of the two different ancestries carrying the Arab-Indian (AI) and African haplotypes. It is not associated with any of the studied clinical variables in this report. Further studies are needed to confirm these findings.

Role of Urinary Matrix Metalloproteinase-7 (MMP-7) as an Early Marker of Renal Dysfunction in Diabetic Individuals: A Cross-Sectional Study.

The matrix metalloproteinase 7(MMP-7) level gets heightened in the urine samples of diabetic individuals with impaired renal function. Renal biopsy is seldom offered because of its invasive nature. These concerns spurred the investigation of relationships between urine MMP-7 levels and the renal function of diabetic individuals. Studies exploring this aspect are scarce. We aimed to evaluate the glycemic and renal parameters of female and male individuals with or without type 2 diabetes mellitus (T2DM) or kidney disease. We also assessed the correlation of urine MMP-7 with various parameters. This prospective, analytical, cross-sectional study was conducted at Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, India, from February 2020 to January 2023. Female and male individuals 18-85 years of age diagnosed with either T2DM, hypertension, or kidney disease were assessed for their glycemic indices and renal parameters. Those with both renal disease and T2DMwere placed in group A. The diabetic individuals without kidney disease constituted group B. People in group C had neither kidney disease nor T2DM. Patients in group D had kidney disease but were not diabetics. The parameters of the male and female participants in each of the four groups were assessed and compared, including: age, body mass index (BMI), fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), serum urea, serum creatinine, estimated glomerular filtration rate (eGFR), urine albumin, urine creatinine, urine albumin-creatinine ratio (ACR), serum sodium, serum potassium, and urine MMP-7 levels. Furthermore, we correlated urine MMP-7 with all these traits. We used R software (version 4.4.0, Vienna, Austria) for data analysis. Two hundred eighty-seven (87.5%) of the 328 individuals we screened were eligible. Of them, group A had the maximum number (94) of participants, followed by B (75), C (65), and D (53). Males comprised 60.3% (n = 173) of the study population. The median age of the participants was 52.0 (44.0-61.1) years. The intergroup variations were statistically significant (p < 0.001) owing to their glycemic status and renal function. The gender-basis comparison of FBS and HbA1c yielded non-significant differences. On the contrary, assessment of the renal parameters revealed significant differences (p < 0.001) between females and males. The study population had a median urine MMP-7 level of 19.9 (1.1-50.5) µg/L. Significant associations with urine MMP-7 were found with serum creatinine (r = 0.91, p < 0.001), urine ACR (r = 0.86, p < 0.001), and eGFR (r = -0.84, p < 0.001). Our study portrayed that male diabetics, in comparison to female diabetics, had greater levels of urine ACR, urine MMP-7, eGFR, and serum creatinine. Moreover, urine ACR, eGFR, and serum creatinine strongly correlated with the urine MMP-7 level.

Alactic base excess (ABE): a novel internal milieu parameter-its concept and clinical importance.

Inspired by the Stewart-Figge acid-base approach, Gattinoni et al. recently introduced a new internal milieu parameter known as alactic base excess (ABE). The authors defined ABE as the sum of lactate and standard base excess. In the context of sepsis, ABE has been proposed as a valuable marker to discern between metabolic acidosis resulting from the accumulation of lactate and the retention of fixed acids, which can occur in cases of renal failure. Multiple studies have demonstrated that a negative ABE value (<-3mmol/L) represents an early marker of renal dysfunction, and significantly correlates with higher mortality rates in septic patients. In conclusion, ABE is a simple and useful parameter that can be used to better interpret a patient's acid-base status, assess renal function, and general prognosis in sepsis. By incorporating ABE into clinical practice, healthcare professionals can enhance their understanding of the complex acid-base imbalances in their patients and tailor more individualized, effective treatment plans.

Cystatin C as an Early Marker of Renal Dysfunction in Patients with Cirrhosis of Liver: A Cross-sectional Study

Introduction: Serum cystatin C has been proposed as a sensitive marker for detecting renal impairment. Renal impairment can often co-exist with liver cirrhosis, as decreased blood flow through the cirrhotic liver can lead to kidney dysfunction. However, its role in patients with liver cirrhosis has not been extensively studied, especially in the detection of early renal impairment. Aim: To investigate whether serum cystatin C could serve as a potential marker for detecting early renal dysfunction in patients with liver cirrhosis. Materials and Methods: This hospital-based cross-sectional study was conducted on 60 patients with liver cirrhosis at Assam Medical College and Hospital, Dibrugarh, Assam, India, from June 2019 to May 2020. All patients were assessed for clinical symptoms and laboratory parameters, focusing on renal function tests, measurement of serum cystatin C levels, and Glomerular Filtration Rate (GFR). A two-tailed p-value &lt;0.05 was considered statistically significant in all calculations. Results: In total, 60 consecutive patients with liver cirrhosis were evaluated during the study period, 85% of whom were males. The mean age was 47.4±9.3 years. The mean values of GFR calculated from the mean values of serum creatinine and serum cystatin C were 59.57±31.48 and 31.25±18.32, respectively, both showing a negative correlation (r=-0.802 and r=-0.817, respectively), indicating that cystatin C has a superior correlation with GFR when compared to serum creatinine. Regression analysis showed a tighter distribution of results around the regression line for cystatin C, as indicated by an R2 value of 0.67, compared to 0.64 for creatinine. It was also observed that for every unit rise in serum creatinine and cystatin C value, GFR decreased by 29.89 and 14.67, respectively. Conclusion: Serum cystatin C is a better predictor of GFR than serum creatinine and can therefore be used as an early marker of renal dysfunction in the course of liver cirrhosis

Cystatin C as an Early Marker of Renal Dysfunction in Patients with Cirrhosis of Liver: A Cross-sectional Study

Cystatin C as an Early Marker of Renal Dysfunction in Patients with Cirrhosis of Liver: A Cross-sectional Study

Biochemical Markers of Early Renal Dysfunction in Patients with β-thalassemia Major: A Systematic Review and Meta-analysis.

Early diagnosis of renal dysfunction in β-thalassemia major (β- TM) may help take specific measures to delay irreversible damage and renal failure. Therefore, the present meta-analysis aimed to compare biochemical markers of premature renal dysfunction between β-TM and healthy subjects and identify renal issues' prevalence in patients with β-TM. We searched PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, Scopus, Web of Science, ScienceDirect, ProQuest, Google Scholar, and State Inpatient Databases (SIDs) without any language constraints for all relevant articles published up to April 2019. Out of 1458 articles published up to April 2019, 24 case-control and 22 crosssectional studies were investigated. The investigated levels of serum phosphorus, uric acid (UA), cystatin C, and ferritin were significantly different between β-TM patients and controls. The albumin/creatinine ratio (ACR), N-acetyl-β-D-glucosaminidase/creatinine (NAG/Cr) ratio, urinary and serum β2 microglobulin (β2MG), and serum ferritin levels were significantly higher in β-TM patients than in healthy individuals. However, glomerular filtration rate, creatinine clearance, and pretransfusion hemoglobin indicated a significantly lower rate. The general prevalence of renal glomerular and/or tubular defects in patients with β-TM was 50.22%. Urinary NAG, β2MG, ACR, and Scys-C may be early markers of renal dysfunction in patients with β-thalassemia major. An observation of elevated levels of these markers despite normal levels of other markers of renal dysfunction may indicate primary, subclinical injury to the renal tubules and glomeruli.

Evaluation of conventional renal function tests in β-thalassemia major patients in Nineveh province

β-thalassemia is an inherited anemia, caused by impaired β-globin chain synthesis. The disease leads to serious health problems unless treated by regular blood transfusion and iron chelating therapy. However, complications from continuous therapy may arise due to iron overload and toxicity of iron chelating therapy, it may affects many organs in the body including the renal system. The present study was directed to study the changes in conventional renal function tests that may occur in β-thalassemia patients. The present study consisted of two groups of β-thalassemia patients; group A, 40 transfusion dependent β-thalassemia patients receiving only regular blood transfusion, age ranged 1-4 years; Group B, 40 transfusion dependent β- thalassemia patients receiving regular blood transfusion and deferroxamine chelation therapy, age ranged 4-20 years old. In addition to a control group C, 40 subjects, age ranged 1-20 years. Blood samples were collected and serum was separated for measurement of creatinine, urea, and ferritin. Urine samples were also collected for measurement of microalbuminuria. There was a significant decrease in serum creatinine, and a significant increase in serum urea in group B when compared with their control (P≤0.01). In addition, there was a significant increase in serum ferritin in groups A and B when compared with their controls (P≤0.01). On the other hand, there were no significant changes in microalbuminuria between groups A and B when compared with their controls. The results of the present study showed no deterioration in renal functions in β-thalassemia patients in both groups A and B regarding serum creatinine and urea in addition to microalbuminuria, although, subclinical alteration in renal functions could be expected in those patients, so that measurement of other early markers of renal dysfunction is occasionally recommended.

(1085) Galectin-3 as an Early Marker of Renal Dysfunction in Heart Transplant Patients: Short-Term Results

(1085) Galectin-3 as an Early Marker of Renal Dysfunction in Heart Transplant Patients: Short-Term Results

SERUM CYSTATIN C AS A PREDICTOR OF THE DEVELOPMENT OF ACUTE KIDNEY INJURY IN NEWBORNS WITH HYPOXIC- ISCHEMIC ENCEPHALOPATHY SUBMITTED TO THERAPEUTIC COOLING

Assessment of renal function in newborns is extremely important and at the same time challenging due to the unique body structure, increased vulnerability and rapid growth of the latter. However, for the early detection of acute kidney injury (АКI), rational dosing of drugs and safe drug therapy, the identification of early markers of renal dysfunction is essential.The objective is to evaluate the prognostic value of serum biomarkers for the early diagnosis of АКI in newborns with hypoxic-ischemic encephalopathy against the background of therapeutic hypothermia and preventive use of methylxanthines.Materials and Methods. A single-center, prospective, randomized trial involving 44 neonates with АКI requiring therapeutic hypothermia and prophylactically receiving caffeine citrate or theophylline to prevent АКI progression was conducted in from 2019 to 2022 on the basis of the NICU of Zaporizhzhia Regional Clinical Children's Hospital.Laboratory analysis of blood serum samples was performed on day 1, day 3 and 5 from birth, creatinine (Cr) and cystatin C (CysC) levels and their associations with the development of АКI were determined according to the neonatal criteria of the 2012 KDIGO guideline.Statistical analysis was performed using Statistica 13.0 program, TIBCO Software Inc. (license number JPZ804I382130ARCN10-J) and Microsoft Excel 2013 (license number 00331-10000-00001-АА404). The probability of the difference in absolute values of mean values was determined using non-parametric methods of statistical analysis: the Mann-Whitney U-Test for unrelated groups and the Wilcoxon signed-rank t test for related groups. Statistical significance was defined as p &lt; 0.0500.The study was performed in accordance with the moral and ethical standards established by the IGH / GCP guidelines, the World Medical Association Helsinki Declaration, adopted in 1964 and amended in 1975, 1983, 1989, 1996 and 2000, The European Convention of Human Rights and Biomedicine and the legislation of Ukraine. The protocol was approved by the Medical Ethics Commission at Zaporizhzhia State Medical University. The study was performed as part of the research project "Optimization of diagnostics and intensive care of polyetiologic lesions of the brain, gastrointestinal tract, and kidneys in newborns and older children" (State registration number O118U007142) of the Pediatric Surgery and Anesthesiology Department of the State Institution "Zaporizhzhia State Medical University of the Ministry of Health of Ukraine."Results and their discussion. In general, AKI according to KDIGO developed in 5.00 (11.36 %) neonates out of 44.00 (100.00 %), stage 0 was found in 39.00 (88.64 %). 4.00 (9.09%) newborns had stage I, and 1 (2.27%) developed stage II; the data obtained were similar: p = 0.7872; U = 230.00. None of the patients progressed to stage III.In the newborns with preserved renal function during the study there was a decrease in Cr and a predictable, by this marker, increase in GFR. A statistically significant increase in Cr level and decrease in GFR was found in the newborns with renal dysfunction on days 3 and 5 of the study. Cr level progressed from baseline 1.07 (0.87; 1.10) mg/dl to 1.13 (0.86; 1.25) mg/dl on day 3 and to 1.40 (1.15; 1.82) mg/dl on day 5, while GFR decreased from 19.76 (19.07; 22.90) ml/min/1.73m2 to 17.97 (13.84; 24.42) ml/min/1.73m2 on day 3 and was 12.38 (11.12; 17.54) ml/min/1.73m2 on day 5, with p &lt; 0.0500.CysC progressively decreased in the neonates without AKI from 2.50 (2.20; 2.60) ng/ml to 2.25 (2.08; 2.49) ng/ml, p = 0.0095; while in the neonates with AKI the level of this marker did not change and was 2.56 (2.41; 2.70) ng/ml on day 1 and 2.42 (1.89; 2.45) ng/ml on day 5, p = 0.2963. As this marker changed, eGFR (CysC) increased progressively in the cohort of patients without kidney damage but did not change in the other group.The diuresis rates in the newborns of both groups did not differ, being ≥ 1.5 ml/kg/h, which is probably due to methylxanthine therapies, p ≥ 0.0500.Conclusions. CysC assessment did not provide additional information on the development of acute kidney injury in neonates (nAKI) in the first 5 days of life, which would have allowed a quick decision to change the intensive care program. Further studies involving newborns who did not receive prophylactic therapy are needed.

Doppler parameters of the renal arterial channel in pregnant women with chronic kidney disease as early markers of renal dysfunction

Doppler parameters of the renal arterial channel in pregnant women with chronic kidney disease as early markers of renal dysfunction

NT-proBNP in assessment of kidney dysfunction development in patients with diffuse large B-cell lymphoma receiving immune polychemotherapy.

e19554 Background: The purpose of this study was to assess NT-proBNP as a marker of renal dysfunction in patients with diffuse large B-cell lymphoma receiving immune polychemotherapy. Methods: The study involved 24 patients aged 23-69 years (median 57 years) with a primary diagnosis of diffuse large B-cell lymphoma (DLBCL). The renal status was assessed by the blood serum levels of creatinine, urea, NT-proBNP (Vitros 5600, USA), sodium (Cobas b221, Switzerland) with the calculation of the glomerular filtration rate (GFR) according to the CKD-EPI formula, as well as urine levels of albumin (Cobas Integra 400 plus, Switzerland). The tests were conducted before and 48 hours after induction immune polychemotherapy (R-CHOP). Statistical evaluation of results was made using the Statistica 13.0 program. Results: The patients were divided into 2 groups depending on the GFR levels before the start of therapy: group 1 (n = 16) - GFR 108.04±13.9 mL/min/1.73 m2 (normal levels); group 2 (n = 8) - GFR 59.57±12.04 mL/min/1.73m2 (reduced levels). The studied parameters in group 1 were within the reference values before treatment: NT-proBNP 109.38±13.6 pg/mL, creatinine 72.67±7.96 μmol/L, urea 5.39±0.99 mmol/L, albumin in urine 4.34±0.51 mg/L. After 48 hours, a moderate increase in NT-proBNP up to 207.5±48.2 pg/mL (p &gt; 0.05) was observed, without significant changes in other parameters. In group 2, a pronounced increase in NT-proBNP was observed initially: 694±206.47 pg/mL, which was 5.6 times higher than the upper limit of the reference interval (p &lt; 0.001) and 6.4 times higher than the levels in group 1 (p &lt; 0.001), together with a significant increase in urine levels of albumin - 43.93±12.03 mg/L. Creatinine (80.67±4.35 μmol/L) and urea (6.4±1.41 mmol/L) remained within the reference range. After 48 hours, NT-proBNP increased by 3.8 times, reaching 2675±602.4 pg/mL (p &lt; 0.001), which was accompanied by an increase in urine albumin - 57.8±8.86 mg/L and serum creatinine – 102.2±5.37 μmol/L in comparison with the initial levels. The levels of urea remained unchanged (6.6±0.43 mmol/L). The sodium levels did not differ significantly between the groups and was 141.65±2.24 mmol/L in group 1 and 140.85±3.4 mmol/L in group 2 and did not change over time. According to the results, patients with an initially decreased GFR demonstrated an increase in the levels of NT-proBNP and albumin in the urine even before the start of polychemotherapy. Conclusions: NT-proBNP can be considered an early marker of renal dysfunction in patients with diffuse large B-cell lymphoma.

Study of Relationship between HbA1c and Microalbuminuria of Diabetic Patients

Background: Globally, as of 2010, an estimated 285 million people had diabetes, with type 2 making up about 90% of the cases. Its incidence is estimated to almost double, by 2030. Diabetic nephropathy is a consequence of long standing diabetes. The prevalence of microalbuminuria predicts progression to diabetic nephropathy. Measurement of glycated hemoglobin (HbA1c) has become the preferred method of diagnosis as well as assessing long-term glycaemic control. The present study was conducted to determine the magnitude and prevalence of microalbuminuria in relation to HbA1c in a group of diabetic patients admitted in Comilla Medical College Hospital of Bangladesh. Objectives: The relationship between HbA1c and microalbuminuria of diabetic patients was assessed in a hospital-based cross-sectional study in a tertiary level hospital.Material &amp; Methods:A hospital-based cross-sectional descriptive study was carried out in department of Medicine, Comilla Medical College Hospital from 1st July, 2011 to 30th June, 2012. One hundred known admitted diabetic patients with age 25–84 years were included in this study.Results:Microalbuminuria had a significant correlation with HbA1c (p&lt;0.05) (r=0.24). Increasing HbA1c was associated with increasing microalbuminuria above optimal cut-off points of HbA1c 7%. The prevalence of microalbuminuria was 33.33 % at HbA1c(6.1-6.9)%, whereas it was 75% at HbA1c (7.1-7.9)%. Microalbuminuria was 38.74 ± 9.76 mg/gm (p&lt;0.05) at HbA1c &lt;7%, whereas it was 65.86 ± 21.29 mg/gm (p&lt;0.05) at HbA1c ≥7%.Conclusions:The present study found an early onset of microalbuminuria in the selected community which could be due to poor glycaemic control (high HbA1c ≥ 7%) after excluding other causes of microalbuminuria. Screening for microalbuminuria and HbA1c test should be done in both newly and already diagnosed diabetic patients as an early marker of renal dysfunction and glycaemic control.

Value of Combined Plasma NGAL, Cystatin C and NT-proBNP in the Diagnosis of Cardiorenal Syndrome Type 1

Background: The presence of acute kidney injury in the setting of acute heart failure (AHF) or acute decompensated heart failure (ADHF) is very common occurrence and was termed cardiorenal syndrome 1 (CRS1). Neutrophil gelatinase-associated lipocalin (NGAL) in the blood and urine is one of the earliest biomarkers of acute kidney injury due to ischemia or renal toxicity. Cystatin C is early marker of renal dysfunction. NT-pro BNP is valuable in the diagnosis, prognosis and treatment of acute and chronic heart failure. This study was aimed to evaluate the diagnostic efficacy of the combination of plasma NGAL, Cystatin C and NTproBNP in diagnosis of CRS1. Methods: there were 139 patients with AHF or ADHF in the department of Cardiovascular resuscitation and Interventional cardiology at Ho Chi Minh City 115People Hospital from November 2018 to May 2019. This was a prospective cohort study. Results: there were 48 cases (rate 34.5%) with CRS1, mean age 66.12 ± 15.77, men accounted for 50.4%. There were no significant differences of vital signs on admission, diagnosis, type of heart failure between CRS1 and Non-CRS1 groups. The urea, creatinin on first day (creatininD1) and third day (creatininD3), NT-pro BNP, Cystatin C, NGAL levels were higher in the group with CRS1 than Non-CRS1, the difference was statistically significant p 353.23 ng/ml, Area Under Curve (AUC)was 0.732 (95% CI 0.65-0.80, p 1.81 mg/dl, AUC was 0.787 (95% CI 0.71-0.85, p &lt; 0.001), sensitivity 53.19%, specificity 77.17%, positive predictive value 54.3%, negative predictive value 76.3%.Combined three biomarker plasma NGAL, Cystatin C and NT proBNP, the specificity of the diagnosis was the highest 95.6%, the positive predictive value was the highest 84.62% in diagnosing CRS1. Conclusions: The combined plasma NGAL, Cystatin C and NT-pro BNP is high value in the diagnosis of CRS1 in patients with AHF or ADHF.

Assessment of Early marker of Renal Dysfunction in Patients with beta – Thalassemia Major with Repeated Blood Transfusions

A case-control study include 60 patients with beta-thalassemia major type with recurrent blood transfusion were visited Babylon center of hereditary blood disorder in Babylon teaching hospital for maternity and children and 60 individuals who seemed to be healthy. This study aimed to assess N-acetyl-beta-glucosaminidase and others renal function and to look for renal complications in those patients if any. These patients and control groups divided into two subgroups according to age, group I were less than 18 year and group II were equal or more than 18 years. The present study’s findings showed that there was a significant difference in the levels of Albumin to creatinine ratio, Beta2-microglobulin, N-Acetyl beta-D-glucosaminidase, serum creatinine level, and blood urea between patients group and its healthy group (p &lt; 0.05). In conclusion, beta-thalassemia major patients frequently have renal hemosiderosis and asymptomatic renal impairment, which are not found in routine renal investigations, it needs regular checks for early detection of tubular and glomerular failure

Value of combined Plasma NGAL, Cystatin C And NT-proBNP in the diagnosis of cardiorenal syndrome type 1

Abstract Background The presence of acute kidney injury in the setting of acute heart failure (AHF) or acute decompensated heart failure (ADHF) is very common occurrence and was termed cardiorenal syndrome 1 (CRS1). Neutrophil gelatinase-associated lipocalin (NGAL) in the blood and urine is one of the earliest biomarkers of acute kidney injury due to ischemia or renal toxicity. Cystatin C is early marker of renal dysfunction. NT-proBNP is valuable in the diagnosis, prognosis and treatment of acute and chronic heart failure. This study was aimed to evaluate the diagnostic efficacy of the combination of plasma NGAL, Cystatin C and NT-proBNP in diagnosis of CRS1. Methods There were 139 patients with AHF or ADHF in the department of Cardiovascular resuscitation and Interventional cardiology at Ho Chi Minh City 115 People Hospital from November 2018 to May 2019. This was a prospective cohort study. Results There were 48 cases (rate 34.5%) with CRS1, mean age 66.12±15.77, men accounted for 50.4%. There were no significant differences of vital signs on admission, diagnosis, type of heart failure between CRS1 and Non-CRS1 groups. The urea, creatinin on first day (creatininD1) and third day (creatininD3), NT-proBNP, Cystatin C, NGAL levels were higher in the group with CRS1 than Non-CRS1, the difference was statistically significant p&amp;lt;0.05. The optimal cut-off NGAL for diagnosing CRS1 was &amp;gt;353.23 ng/ml, Area Under Curve (AUC) was 0.732 (95% CI 0.65–0.80, p&amp;lt;0.001), sensitivity 74.47%, specificity 68.48%, positive predictive value 54.7%, negative predictive value 84%. The optimal cut-off Cystatin C for diagnosing CRS1 was &amp;gt;1.81 mg/dl, AUC was 0.787 (95% CI 0.71–0.85, p&amp;lt;0.001), sensitivity 75%, specificity 83.52%, positive predictive value 70.6%, negative predictive value 86.4%. The optimal cut-off NT-proBNP for diagnosing CRS1 was 17681 pg/ml, AUC was 0.683 (95% CI 0.59 – 0.76, p&amp;lt;0.001), sensitivity 53.19%, specificity 77.17%, positive predictive value 54.3%, negative predictive value 76.3%. Combined three biomarker plasma NGAL, Cystatin C and NTproBNP, the specificity of the diagnosis was the highest 95.6%, the positive predictive value was the highest 84.62% in diagnosing CRS1. Conclusions The combined plasma NGAL, Cystatin C and NT-proBNP is high value in the diagnosis of CRS1 in patients with AHF or ADHF. Funding Acknowledgement Type of funding sources: None.

CIRCULATING METABOLIC BIOMARKERS AS POTENTIAL LEADS FOR GLOBAL PREVENTION OF RENAL DYSFUNCTION – A FLEMISH COHORT STUDY

Objective: Studies of people with normal or slightly impaired renal function offer a unique setting to explore the metabolic profiles associated with the early renal dysfunction. Design and method: In 578 randomly recruited Flemish, we assessed at a 5 year interval the multivariable-adjusted associations of estimated glomerular filtration rate (eGFR, ml/min/1.73 m2) with 43 circulating metabolites quantified by non-targeted nuclear magnetic resonance spectroscopy. Significance of associations, expressed per 1-SD increment in the metabolites, were Bonferroni corrected. Results: At baseline (2005–2010), glycine was associated with a 1.81 lower eGFR (P = 0.011). At follow-up (2009–2013), threonine (-2.14) and glycine (-1.73) were cross-sectionally associated with lower eGFR (P &lt; = 0.02) and aspartate (+2.23), leucine (+2.30) and 2 aminobutyrate (+2.12) with higher eGFR (P &lt; = 0.0033). At follow-up, the odds ratio of having eGFR &lt; 60 was 1.62 for threonine and 1.44 for glycine (P &lt; = 0.039). Partial least squares analyses of baseline and follow-up data were confirmatory. For baseline glycan N acetylglucosamine residues (GlycA), a marker of systemic inflammation, the odds ratio of progressing towards follow-up eGFR &lt; 60 vs. non-progressing (n = 49 vs. 529) was 1.85 (P = 0.0086). Baseline GlycA was a better predictor than 24 h microalbuminuria, increasing (P &lt; = 0.0001) the integrated discrimination (+3.4%) and net reclassification (+40.1%) indexes. Pathway analysis pointed to aminoacyl-tRNA biosynthesis, glycine, serine and threonine metabolism, valine, leucine and isoleucine metabolism, and glycolysis or gluconeogenesis. Conclusions: The glycine to threonine pathway and systemic inflammation as reflected by GlycA are markers of early renal dysfunction, whereas protection against oxidative stress and anaplerotic energy supply from the catabolism of branched amino acids (leucine) might be protective.

Association of environmental cadmium exposure and bone remodeling in women over 50 years of age

Chronic cadmium (Cd) toxicity is a significant health concern, and the mechanism of long-term low-dose Cd exposure on bone has not been fully elucidated yet. This study aimed to assess the association between long-term environmental Cd exposure and bone remodeling in women who aged over 50. A total of 278 non-smoking subjects from Cd-polluted group (n = 191) and non-Cd polluted group (n = 87) were investigated. Bone mineral density (BMD), the levels of three bone turnover markers (BTMs), including total procollagen type 1 amino-terminal propeptide (P1NP), collagen type 1 cross-linked C-telopeptide (β-CTX), bone-specific alkaline phosphatase (BALP), together with serum soluble receptor activator of nuclear factor-κB ligand (sRANKL) and osteoprotegerin (OPG) were determined. Early markers of renal dysfunction were measured as well. Urinary Cd concentrations ranged from 0.41 to 87.31 μg/g creatinine, with a median of 4.91 μg/g creatinine. Age, BMD, T-score, and prevalence of osteoporosis showed no statistical differences among the quartiles of urinary Cd concentrations, while serum levels of P1NP, β-CTX, and OPG were higher in the upper quartiles. Multivariate linear regression models indicated significantly positive associations of urinary Cd concentration with serum levels of P1NP, β-CTX, BALP, sRANKL, and OPG. A ridge regression analysis with T-score and the three BTMs, sRANKL, and OPG, adjusted for age and body mass index (BMI), indicated that except for age and Cd exposure, β-CTX was a predictor of T-score. These findings demonstrated that Cd may directly accelerate bone remodeling. Serum β-CTX might be an appropriate biochemical marker for evaluating and monitoring Cd-related bone loss.Capsule: Cadmium (Cd) may directly accelerate bone remodeling and serum β-CTX is a valuable biochemical marker for evaluating Cd-related bone loss.

Comparative assessment of renal function by cystatin C level in patients with hypertension and extrasystole

Although the tight connection of the cardiovascular system and the kidneys is well known, using of cystatin C (Cys-C) opens new horizons in studying early renal failure stages. The study aimed to compare the functional status of the kidneys in patients with hypertension and extrasystole to the level of Cys-C. 156 patients with stage II hypertension (EH II) were examined. 124 of them had frequent symptomatic extrasystoles (74 – of supraventricular origin and 50 – ventricular), 32 patients had no arrhythmias, and were referred to the comparison group. The control group consisted of 30 healthy people with normal blood pressure (BP). All patients underwent a complete clinical examination, blood pressure measurement, daily blood pressure monitoring, daily electrocardiogram monitoring, echocardiography, and determination of renal function (creatinine, blood electrolytes, serum cystatin C) followed by calculation of glomerular filtration rate (GFR). The level of Cys-C in patients with hypertension was significantly higher (p&lt;0.001) compared with healthy individuals. Among patients with arrhythmias, the highest level of Cys-C was noted in patients with ventricular arrhythmias. The correlation analysis showed that the level of Cys-C was higher in the presence of frequent extrasystoles (namely of ventricular origin), smoking, high blood pressure, increased systolic and pulse blood pressure, the presence of concentric left ventricular hypertrophy, dyslipidemia, increased creatinine level and decreased GFR. All three EH II patient groups had significantly lower GFR (calculated by creatinine level) (p&lt;0.001). The lowest creatinine-based GFR was revealed in patients with ventricular extrasystole. All patients with EH II had significantly lower Cys-C based GFR than the control group (p&lt;0.001). Mean Cys-C-based GFR values in patients with extrasystole were significantly lower than in patients without extrasystole (p&lt;0.03). The analysis of GFR levels depending on the extrasystole origin was provided. The lowest level of GFR was recorded in patients with ventricular extrasystole. It was significantly different from the patients with supraventricular extrasystole (p=0.02). Our findings confirm the opinion of other researchers that Cys-C is an early marker of renal dysfunction in patients with hypertension, which is more sensitive than creatinine. Another finding is that ventricular extrasystole is more hemodynamically and metabolically unfavorable compared to supraventricular based on clinical and prognostic evaluation.

Serum neutrophil gelatinase-associated lipocalin as an early biomarker of acute kidney injury in subjects undergoing percutaneous transluminal coronary angiogram with normal EGFR

Introduction: Detecting AKI in a timely fashion with the current AKIN staging criteria is a challenge because the diagnosis of AKI is usually based on changes in serum creatinine (SCr) which is a poor marker of early renal dysfunction. Aim: To study the role of Serum Neutrophil Gelatinase-Associated Lipocalcin (NGAL) as early biomarker for the detection of Contrast induced acute kidney injury (CIAKI) in subjects undergoing Percutaneous transluminal coronary angiogram (PTCA) with normal eGFR. Materials and Methods: Prospective cohort study was conducted, where SCr and serum NGAL were serially measured in a heterogeneous group of subjects (n=60) presenting to cardiology department. Results: The study population consisted of 60 subjects. All subjects were divided into 2 groups “CIAKI group” and “no-CIAKI group” according to predefined definition. The serum NGAL increased and reached its peak at 4 hours after contrast media (CM) administration and did not returned to baseline by 24 hours while the SCr increased at 24 hours and reached peak at 48 hours respectively (P

The impact of dyslipidemia on early markers of endothelial and renal dysfunction in children

BackgroundDyslipidemia has been associated with endothelial dysfunction in childhood. Impairment of renal function has been demonstrated in dyslipidemic adults. ObjectiveThe aim of this study was to assess markers of early endothelial and renal dysfunction in dyslipidemic children. MethodsThis was a cross-sectional study of 100 children with dyslipidemia and 100 age- and sex-matched control subjects without dyslipidemia aged 7–16 years. Renal dysfunction was assessed by measurement of serum creatinine and cystatin C levels, urinary beta 2-microglobulin levels, urinary albumin to creatinine (Alb:Cr) ratio, and by the estimated glomerular filtration rate (eGFR), based on serum creatinine or cystatin C. Endothelial dysfunction and early vascular changes were evaluated by ultrasound assessment of flow mediated dilation (FMD) of the brachial artery, and carotid intima-media thickness (cIMT), respectively. ResultsThe markers of early renal dysfunction showed no difference between the dyslipidemic children and control subjects except for the urinary Alb:Cr ratio that was higher in the dyslipidemic children (median, 0.007 mg/mg vs 0.005 mg/mg, p = 0.004). The urinary Alb:Cr ratio was positively correlated with the triglyceride to high-density lipoprotein cholesterol ratio (r = 0.28, p = 0.013). FMD values were lower in the dyslipidemic children than in the control subjects (8.504 ± 4.73% vs 10.535 ± 4.35%, p = 0.004), but cIMT did not differ between groups. This decrease in FMD values was evident in children aged ≥10 years. FMD was independently associated with the level of lipoprotein (a) (beta = −0.29, p = 0.01). ConclusionAmong markers of endothelial and renal dysfunction investigated, FMD was found to be lower and the urinary Alb:Cr ratio higher in children with dyslipidemia.