Mean Creatinine Research Articles

Insuffisance rénale aiguë et paludisme grave chez l’adulte : étude descriptive monocentrique à Madagascar en utilisant les critères KDIGO

IntroductionAcute Kidney Injury (AKI) is one of the criteria for severe malaria with a varied incidence. Our objectives are to determine the prevalence of malaria-associated AKI and to report the characteristics of patients with the evolution of cases. Patients and methodThis is a 5-year retrospective descriptive study from January 1, 2015 to December 31, 2019 in the Infectious Diseases department of the University Hospital Center of Befelatanana Antananarivo. Among 379 patients diagnosed, 103 patients (27,18%) with associated AKI were included. We used the criteria of Kidney Disease Improving Global Outcomes group to define AKI. ResultsThe prevalence of AKI was 27.18%. The mean age of patients was 34.92 years and the sex-ratio was 3.68. Plasmodium falciparum was the causative agent in 98.06% of cases followed by Plasmodium vivax. Diuresis was preserved in 69.86% of cases. Jaundice was the main sign of severity associated (49.51%). The mean creatinine level was 466.93μmol/L. The evolution was favorable under antimalarial drug and rehydration. Dialysis was required in 25.24% of cases. Thirteen patients had died, a rate of 12.62%, of which 8 patients (61.54%) had dialysis criteria but had not been purged for economic reasons. ConclusionAKI is a frequent complication of malaria. It is responsible for significant mortality despite improved care in the fight against malaria.

Low bleeding and stroke rates with minor age-dependent increase confirm the safety and effectiveness of edoxaban in patients with atrial fibrillation across age groups: Two-year results from ETNA-AF

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Daiichi Sankyo Background Age is a risk factor for ischemic stroke and bleeding in patients with atrial fibrillation (AF). The large dataset from the global prospective, noninterventional ETNA-AF program allows for analysis of the impact of age on clinical events in AF patients treated with edoxaban. Purpose Evaluate the safety and effectiveness of edoxaban by age subgroups and the impact of age on clinical events. Methods Baseline patient characteristics, thromboembolic and bleeding events, and mortality data were collected from patients with 2-year follow-up in ETNA-AF program and analyzed in defined age subgroups. Cox regression analysis was conducted using age as a continuous variable and clinical events as outcome variables. Results A total of 27,617 patients were categorized into four age subgroups: <65, 65-74, 75-84 and ≥85 years. Patient demographics and baseline characteristics are shown in the Table. Percentage of male, mean body weight, and mean creatinine clearance decreased with age, whereas percentages of patients with heart failure, patients on reduced dose edoxaban 30 mg, mean stroke and bleeding risk scores increased with age. The annualized rates of ischemic stroke and major bleeding increased with age, yet remained low. Importantly, the rate of intracranial hemorrhage was low across age groups, including the ≥85 years group. The hazard ratio (HR) for ischemic stroke was 1.041 (95%CI 1.028-1.053), ie. with a 1-year increase in age, the risk of ischemic stroke increased by 4.1%. The HRs for other clinical events were: major bleeding 1.044 (95%CI 1.033-1.055), intracranial hemorrhage 1.027 (95%CI 1.007-1.046), major gastrointestinal bleeding 1.065 (95%CI 1.048-1.081), all-cause mortality 1.086 (95%CI 1.079-1.093). Conclusion Two-year follow-up data from the global ETNA-AF program support the use of edoxaban as a safe and effective treatment for AF patients across all age groups, including the very elderly, in routine clinical care. The impact of age on the risk of ICH was smaller than that of ischemic stroke and major bleeding. <65 yr(N = 4,278) ≥65-74 yr(N = 9,396) ≥75-84 yr(N = 10,728) ≥85 yr(N = 3,214) Age [years], mean (SD)Male, %Weight [kg], mean (SD) 57.3 (6.6)72.580.6 (20.3) 69.9 (2.9)61.973.0 (17.7) 79.1 (2.8)53.968.0 (16.0) 87.9 (2.8)42.260.1 (14.9) CrCL [mL/min], mean (SD)CHA2DS2-VASc, mean (SD)Mod. HAS-BLED≠, mean (SD) 101.8 (33.7)1.6 (1.1)1.4 (1.0) 75.3 (22.3)2.8 (1.2)2.5 (1.1) 57.9 (18.1)4.1 (1.2)2.7 (1.0) 42.5 (14.3)4.4 (1.3)2.7 (1.0) 2-year clinical events Major Bleeding (ISTH)%/yr [95% CI] Intracranial Hemorrhage%/yr [95% CI] Major GI Bleeding%/yr [95% CI] 0.49 [0.35; 0.68] 0.18 [0.09; 0.30] 0.22 [0.13; 0.36] 0.84 [0.70; 0.99] 0.26 [0.18; 0.34] 0.34 [0.26; 0.44] 1.16 [1.00; 1.32] 0.31 [0.23; 0.40]0.60 [0.49; 0.72] 1.88 [1.51; 2.30] 0.46 [0.29; 0.69]1.19 [0.90; 1.53] Any Stroke%/yr [95% CI]Ischemic Stroke%/yr [95% CI]Hemorrhagic Stroke%/yr [95% CI] 0.54 [0.38; 0.73]0.38[0.26; 0.56]0.12[0.06; 0.23] 0.79 [0.66; 0.94]0.59[0.47; 0.71]0.19[0.13; 0.27] 1.15 [1.00; 1.32]0.89[0.76; 1.04]0.23[0.16; 0.31] 1.53 [1.21; 1.92]1.21[0.92; 1.56]0.320.18; 0.52] All-cause Death%/yr [95% CI]CV Death (sensitivity)%/yr [95% CI] 1.05 [0.83; 1.32]0.51[0.36; 0.70] 1.82 [1.62; 2.04]0.83[0.69; 0.98 3.51 [3.25; 3.80]1.65[1.47; 1.84] 9.08 [8.27; 9.96]4.16[3.62; 4.77] ≠Excluding labile INR.

Effect of Aqueous Leaf Extract of Dissotis Roundifolia on Plasma Glucose and Creatinine Concentration in Normal Albino Rats

Dissotis rotundifolia?is a broad spectrum medicinal plant that has received worldwide recognition. This study was designed to investigate the effect of aqueous leaf extract of Dissotis rotundifolia on plasma glucose and creatinine level in normal albino rats. A total of 6 albino wistar rats each weighing 150g were assembled and randomly divided into 2 groups (control and tests) consisting of 3 rats each. The control group received pelleted growers mash and distilled water all through the period of experiment while the test group received 2ml/kg body weight of extract twice daily. Blood samples was collected into lithium heparin bottle for creatinine and sodium oxalate tube for glucose determination. The data obtained were subjected to statistical analysis using SPSS version 20. Results showed a significant increase in the mean plasma glucose and creatinine levels in rats treated with Dissotis rotundifolia compared with normal control group. This suggests a deleterious effect of Dissostis rotundifolia at the investigated dosage and thus, may not be safe for oral consumption. Hence, there is need for further studies in this regard in order to ascertain the safety of Dissostis rotundifolia.

Prevalence of Dengue Serotypes and Its Correlation With the Laboratory Profile at a Tertiary Care Hospital in Northwestern India.

Background and aimDengue fever is an emerging arboviral public health problem in a large endemic population in the tropical and sub-tropical areas of the world, with varying degrees of clinical presentation. This study was aimed at analyzing the clinical and laboratory dynamics of the four dengue serotypes.MethodsThis institutional review board (IRB)-approved hospital-based observational study was performed with 100 in-patients with dengue infection above 12 years of age, without co-morbidities or known malignancy, in a tertiary care center in Northern India.ResultsOut of 100 patients, four had concurrent infection with two serotypes. Dengue virus serotype-2 (DENV 2) was the most common serotype (34%) and had the maximum percentage of cases of severe dengue (20.6%). The mean total leukocyte count did not differ between the serotypes. DENV 4 had a significantly higher mean neutrophil percentage and a significantly lower mean lymphocyte percentage than DENV 1 (p-value 0.001 and 0.02, respectively), with a higher percentage of cases of severe dengue (20% vs 14.3%, non-significant). Thrombocytopenia was present in all serotypes of infection. There was a significant difference in the derangement of liver function in DENV 2, 3, and 4 as compared to DENV 1. Mean serum albumin levels were significantly lower in DENV 3 and 4 infections. Cases with co-infection had a much higher derangement of liver function and lower mean serum albumin than infections with a single serotype. The mean blood urea and creatinine levels were in the normal range for all serotypes. No mortality occurred in our study.ConclusionDENV 2 is the most common serotype with maximum severity at our hospital. DENV 2 and DENV 4 have a high percentage of cases with severe dengue (20.6% and 20%, respectively). The mean lymphocyte percentage was significantly lower while hepatic involvement and hypoalbuminemia were greater in DENV 4. Initial serotyping in patients with dengue can help monitor the epidemiological trends and help estimate the clinical and laboratory trends of the different serotypes of dengue infection. Particular care should be taken in patients with co-infection.

Hyper-Interleukin-6 Protects Against Renal Ischemic-Reperfusion Injury-A Mouse Model.

Background: Most of the ischemia-reperfusion injury (IR-I) occurs during reperfusion and is mediated by the immune system. In this study we determined whether immunomodulation with hyper-Interleukin-6 (a recombinant designer cytokine composed of interleukin-6 linked to its soluble receptor) is protective against IR-I in mice kidneys.Methods: Hyper-Interleukin-6 (HIL-6) was administered by in vivo plasmid DNA transfection to 10 male mice. Twenty-four hours later, unilateral nephrectomy was done. IR-I immediately followed by closure of the remaining kidney vascular pedicle for 40 min. Seven mice transfected with non-coding control plasmid served as the control group. The functional and morphological effects of IR-I and its effect on mice longevity were explored. This was done by serial blood tests and by histopathology done upon sacrifice of the animals at post-operative day 7.Findings: Mice pretreated with HIL-6 had a mean creatinine level at post-operative day 1 of 35.45 ± 4.03 μmol/l and mean Urea level was 14.18 ± 2.69 mmol/l, whereas mean creatinine was 89.33 ± 69.27 μmol/l (P = 0.025), and mean urea was 38.17 ± 20.77 mmol/l (P = 0.0024) in the control group. Histological changes in the control group included inflammatory infiltration, tubular damage, and architectural distortion. These were not seen in the treatment group. Seven days post-operatively the survival rate of treated mice was 100% compared to 50% in the control group (P = 0.015).Interpretation: In this single kidney mouse model, pretreatment with HIL-6 administration effectively protected against IR-I both morphologically and functionally. Further studies are needed to better understand the mechanism and feasibility of using this immunomodulator.

Predictors of early and late re-hospitalization and mortality in non-ST elevation myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Regarding prognosis, acute coronary syndromes (ACS) are heterogeneous. Non-ST elevation myocardial infarction (NSTEMI) is a subtype of ACS. In-hospital (IH) and post-hospitalization (PH) risk stratification is crucial. Objective To identify predictors of IH and PH mortality (early and late), as well as predictors of early and late re-admission (RA) in our center population suffering NSTEMI, using real-life data. Methods Based on a single-center retrospective study, data collected from admissions between 1/01/2018 and 11/12/2019. Patients (pts) who survived the ACS and were discharged from the hospital were included. Concerning prognosis, we assessed 1-month M and RA (1mM and 1mRA), 6-month M and RA (6mM and 6mRA), 1-year M and RA (1yM and 1yRA). Results 268 pts with ACS, 59.7% were males and mean age was 66.4 ± 12.5 years old. NSTEMI was the diagnosis in 66.4% and ST elevation myocardial infarction (STEMI) in 31%. Mean creatinine was 1.2 ± 1ml/min, mean sodium was 138 ± 3mmol/L, mean blood urea nitrogen (BUN) was 21 ± 12mg/dL and mean haemoglobin (Hb) was 13.6 ± 1.9g/dL. 88.2% of the pts presented in Killip-Kimball class (KKC) 1, 5.7% in KKC 2, 5.7% in KKC 3 and 0.4% in KKC IV; furthermore, 4.1% of the pts presented de novo AF. Concerning coronary artery disease, 250 were submitted to coronary angiography – 18.8% had no lesions or non-significant lesions (stenosis <50%), 34.8% had one significant lesion, 23.2% had 2 significant lesions and 23.2% had 3 or more. Regarding left ventricle (LV) function, 70.5% of the pts had no LV dysfunction, 15.7% had mild LV impairment (LVI), 9.3% moderate LVI and 4.5% had severe LVI. 8.4% of the patients experienced IH complications, such as auriculoventricular block, heart failure, ventricular tachycardia, stroke, cardiorespiratory arrest and major haemorrhage, during hospitalization. 1mM rate was 1.9% and 1yM rate was 7.8%. KKC (p = 0.001), BUN (p = 0.007), LV function (p= 0.001) and de novo AF (p = 0.46) were predictors of 1mM. Age (p = 0.004), KKC (p = 0.031), BUN (p = 0.002), sodium (p = 0.037), creatinine (p = 0.001), Hb (p = 0.003), LV function (p < 0.001), de novo AF (p < 0.001) and occurrence of IH complications (p < 0.001) were predictors of 1yM. Age (p = 0.010), male gender (p = 0.19), Hb (p = 0.031), de novo AF (p < 0.001) and occurrence of IH complications (p = 0.001) were predictors of 1mRA. Age (p = 0.004), smoking (p = 0.040), hypertension (p = 0.040), glycemia at admission (p = 0.031), Hb (p = 0.004), LV function (p = 0.019), de novo AF (p < 0.001) and occurrence of IH complications (p < 0.001) were predictors of 1yRA. Conclusion This study suggests that de novo AF and occurrence of IH complications are very important prognosis factors regarding early and late mortality and readmission rates.

Evaluation of the Effect of Jatropha integerrima (Euphorbiaceae) on the renal Function of Male Albino Wistar Rats Exposed to Chromium

Aim: The aim of the study was to evaluate the effect of Jathropha interrigima on renal function of male Albino Wistar rats exposed to chromium.
 Study Design: The study is an experimental study.
 Place and Duration of Study: Department of Animal and Environmental Biology, Rivers State University, Port Harcourt, Nigeria, between March 2020 and December 2020.
 Methodology: A total of 30 male Albino Wistar rats that weighed between 140-210g were used for this study. This study was done in three phases: Acute, Sub-chronic and Chronic phases and Jathropha interrigima extract was given to the rats as a prophylaxis (PRE) within the three phases and as a therapeutic (POST) substance within the three phases. Blood samples were collected at the end of each phase for both PRE and POST by cardiac puncture and separated into microvials tubes for the evaluation of the renal parameters listed above using a Selectra Pro-S automated chemistry analyzer. The kidneys were also harvested for histological studies using haematoxilin stain. Data was analysed using SPSS version 22.0 and p values less than 0.05 were considered statistically significant.
 Results: For the Acute Phase, the rats exposed to Chromium (Treatment Group) given the Jathropha extract prophylactically(PRE) had mean Potassium level( 7.33 ± 0.51mmol/l) which was significantly higher than the positive control (5.5 ± 0.42mmol/l); whereas for the Treatment group given the Jathropha extract therapeutically (POST) had mean Sodium level (134.7 ± 2.08mmol/l) which was significantly higher than the negative control (126.5 ± 2.21mmol/l) and the positive control( 130.0 ± 0.01mmol/l), also a CRP level (1.6 ± 0.06u/ml) which was significantly higher than the PC ( 1.5±0.0u/ml1) and NC (1.3± 0.01u/ml) and a KIM level (16.7±0.10u/ml) which was significantly higher than the PC(14.3±0.01u/ml) and NC ( 1.3±0.01u/ml) respectively. In the Sub-chronic phase, Rats in the PRE had TG mean CRP (1.5±0.42u/ml) and KIM (16.1±1.72iu/l) which were significantly higher than the NC and PC (1.2±0.07); whereas those in POST had mean Potassium level (4.5 ± 0.20) which was significantly lower than PC and NC, a mean Bicarbonate level (20.0 ± 1.00) which was higher than PC and NC. And an Anion Gap (12.7 ± 0.58) which was significantly lower than the controls. Mean CRP, KIM, Urea and Creatinine levels in the treatment group where significantly lower than in the controls. A similar result occurred at the chronic phases for both PRE and POST. 
 Conclusion: The results of this study indicate that exposure to Chromium caused a Renal injury and Jathropha interrigima may have the potential to heal or reverse the injurious effect if given as a therapy for upto 30 to 60 days.

FREQUENCY AND CORRELATES OF MYOPATHY IN PATIENTS WITH DIABETES TAKING ATORVASTATIN

Objective: To determine the myopathy in patients with diabetes taking atorvastatin and look for the factors correlated with the presence of myopathy among these patients.
 Study Design: Cross sectional analytical study.
 Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital Rawalpindi from, Jul to Dec 2018.
 Methodology: A total of 166 patients of both genders with type 2 diabetes mellitus taking atorvastatin for at least three to twelve months were included. Blood samples were drawn and Creatinine kinase (CK) levels were determined by automated analysis by colorimetry. Myopathy was taken as muscle symptoms associated with elevations in Creatinine Kinase at least 10 times the upper limit of normal.
 Results: Mean age of patients was 51.530 ± 5.70 years with age range from 40-70 years with. Mean duration of diabetes was 6.174 ± 2.27 years, mean duration of taking atorvastatin 7.186 ± 2.17 months and mean creatinine kinase levels were 1760.325 ± 5111.71 IU/L. Males were 68.7% as compare to females 31.3%. Myopathy was seen in 8.4% patients. Long duration of Diabetes Mellitus and atorvastatin use was statistically significantly related with the presence of myopathy.
 Conclusion: Myopathy was found in a significant number of patients taking atorvastatin. High risk population in our study emerged out to be patients with long duration of Diabetes Mellitus and long use of atorvastatin.

INCREASED CREATININE LEVELS AMONG HEAT EXPOSED WORKERS IN GROBOGAN TILES INDUSTRY, CENTRAL JAVA, INDONESIA

Heat pressure in the tile production process occurs during the drying and burning stages. This working climate can lead to dehydration and more severe clinical consequences such as kidney problems and elevated creatinine levels in workers. This cross-sectional study involved 41 tile workers in Karangasem Village, Wirosari Grobogan District. This study aims to determine the relationship between age, BMI, body temperature, history of energy drinking disease, smoking habits, water consumption, length of work, and physical activity with creatinine levels. Data analysis was in the form of univariate, bivariate and multivariate analysis and this research had conducted etical clearance. The results of this study are the variable age has an mean value of 33.59, the mean BMI of the respondents is 22.037 kg / m2, the mean creatinine level is 1.102 mg / dL, the length of work has an mean value of 8.56 hours, the mean body temperature is 37.12 ℃, total water consumption has a mean of 2.329 liters, the mean number of cigarettes smoked is 6.12 cigarettes per day and the mean physical activity is 1475.83 MET. Creatinine levels in the blood in workers who are not normal as many as 15 people (36.6%). History of disease, water consumption and age are related to blood creatinine levels. Meanwhile, the most dominant variables based on the logistic regression test were water consumption and age.

Prevalence of undiagnosed pre-diabetes or diabetes in patients with HFpEF presenting in the emergency department

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Heart failure with preserved ejection fraction (HFpEF) has become a common cause of visiting the emergency department (ED). Type 2 diabetes mellitus (T2DM) is one of the important predisposing factors. Purpose To study the prevalence of undiagnosed pre-diabetes or T2DM in the patients visiting the ED due to HFpEF. Methods 93 consecutive patients without known history of T2DM visited the ED with signs and symptoms of heart failure. Left ventricular ejection fraction (LVEF) was calculated using bedside ECHO. LVEF > 50% was used to classify HFpEF patients. HbA1c was measured to all patients and the cutoff for T2DM was HbA1c > 6.5% and for pre-diabetes 5.7-6.4%. Body mass index (BMI), brain natriuretic peptide (BNP) , creatinine and hemoglobin (Hb) were also recorded. Results are interpreted as mean ± SD. Results Mean age was 56 ± 11.8 years. 64/93 (68.8%) were female and 29/93(26.97%) male. Mean BMI was 36.52 ± 7.34 kg/m2 and mean Hb 13.51 ± 3.45 g/dl. Mean BNP was 584.82 ± 212.97 pg/ml. Mean creatinine was 1.11 ± 0.36mg/dl. 19/93 (17.67%) patients had HbA1c > 5.7-6.4% and were classified as pre-diabetics and 23/93(21.93%) had HbA1c > 6.5% and were classified as diabetics. We did not identify any correlation between the rest of the parameters. Coclusion 44.64% of the patients that visited ED due to signs or symptoms of HFpEF were identified as having either pre-diabetes or T2DM. Taking into consideration the importance of the presence of T2DM in the prognosis of the patients with HFpEF, it would be reasonable to screen all patients with HFpEF for T2DM and suggest specialized treatment.

Genomic Epidemiology of SARS-CoV-2 Infection During the Initial Pandemic Wave and Association With Disease Severity

Understanding of SARS-CoV-2 variants that alter disease outcomes are important for clinical risk stratification and may provide important clues to the complex virus-host relationship. To examine the association of identified SARS-CoV-2 variants, virus clades, and clade groups with disease severity and patient outcomes. In this cross-sectional study, viral genome analysis of clinical specimens obtained from patients at the Cleveland Clinic infected with SARS-CoV-2 during the initial wave of infection (March 11 to April 22, 2020) was performed. Identified variants were matched with clinical outcomes. Data analysis was performed from April to July 2020. Hospitalization, intensive care unit (ICU) admission, mortality, and laboratory outcomes were matched with SARS-CoV-2 variants. Specimens sent for viral genome sequencing originated from 302 patients with SARS-CoV-2 infection (median [interquartile range] age, 52.6 [22.8 to 82.5] years), of whom 126 (41.7%) were male, 195 (64.6%) were White, 91 (30.1%) required hospitalization, 35 (11.6%) needed ICU admission, and 17 (5.6%) died. From these specimens, 2531 variants (484 of which were unique) were identified. Six different SARS-CoV-2 clades initially circulated followed by a rapid reduction in clade diversity. Several variants were associated with lower hospitalization rate, and those containing 23403A>G (D614G Spike) were associated with increased survival when the patient was hospitalized (64 of 74 patients [86.5%] vs 10 of 17 patients [58.8%]; χ21 = 6.907; P = .009). Hospitalization and ICU admission were similar regardless of clade. Infection with Clade V variants demonstrated higher creatinine levels (median [interquartile range], 2.6 [-0.4 to 5.5] mg/dL vs 1.0 [0.2 to 2.2] mg/dL; mean creatinine difference, 2.9 mg/dL [95% CI, 0.8 to 5.0 mg/dL]; Kruskal-Wallis P = .005) and higher overall mortality rates (3 of 14 patients [21.4%] vs 17 of 302 patients [5.6%]; χ21 = 5.640; P = .02) compared with other variants. Infection by strains lacking the 23403A>G variant showed higher mortality in multivariable analysis (odds ratio [OR], 22.4; 95% CI, 0.6 to 5.6; P = .01). Increased variants of open reading frame (ORF) 3a were associated with decreased hospitalization frequency (OR, 0.4; 95% CI, 0.2 to 0.96; P = .04), whereas increased variants of Spike (OR, 0.01; 95% CI, <0.01 to 0.3; P = .01) and ORF8 (OR, 0.03; 95% CI, <0.01 to 0.6; P = .03) were associated with increased survival. Within weeks of SARS-CoV-2 circulation, a profound shift toward 23403A>G (D614G) specific genotypes occurred. Replaced clades were associated with worse clinical outcomes, including mortality. These findings help explain persistent hospitalization yet decreasing mortality as the pandemic progresses. SARS-CoV-2 clade assignment is an important factor that may aid in estimating patient outcomes.

Nusinersen treatment in adult patients with spinal muscular atrophy: a safety analysis of laboratory parameters

BackgroundNusinersen is an intrathecally administered antisense oligonucleotide (ASO) that improves motor function in patients with spinal muscular atrophy (SMA). In addition to efficacy, the safety of a therapy is the decisive factor for the success of the treatment. For some ASOs, various organ toxicities have been described, such as thrombocytopenia, renal and liver impairment, or coagulation abnormalities. However, systematic data on laboratory parameters under treatment with nusinersen are mainly available from studies in infants and children. Therefore, our aim was to assess the safety of nusinersen therapy in adult SMA patients.MethodsLaboratory data from 404 nusinersen injections performed in 50 adult patients with SMA type 2 and type 3 were retrospectively analyzed.ResultsThe total observation period was 76.9 patient-years, and patients received up to 12 injections. Our data provides no new safety concerns. In cerebrospinal fluid (CSF), the mean white blood cell count and lactate remained stable over time. Total CSF protein increased by 2.9 mg/dL. No change in mean platelet count was observed under therapy. Only one patient showed sporadic mild thrombocytopenia. Coagulation parameters and inflammatory markers were stable. The mean creatinine level decreased by 0.09 mg/dL. Analysis of mean liver enzyme levels revealed no relevant changes during treatment.ConclusionOur data demonstrate a favorable safety profile of nusinersen therapy in adult SMA patients under longer-term “real-world” conditions. In particular, we found no evidence of clinically relevant platelet declines, coagulopathies, or renal or hepatic organ toxicities, which are common concerns with the use of ASOs.

Anti-neutrophil cytoplasmic antibody associated glomerulonephritis complicating treatment with hydralazine

Hydralazine, a widely used therapy for hypertension and heart failure, can elicit autoimmune disease, including anti-neutrophil cytoplasmic antibody associated glomerulonephritis (ANCA-GN). We identified 80 cases of ANCA-GN complicating treatment with hydralazine, accounting for 4.3% (80/1858 biopsies) of ANCA-GN diagnosed between 2006 and 2019. Over three-fourths of patients were on hydralazine for at least one year, with mean daily dose of approximately 250 mg/day. ANCA testing revealed p-ANCA/myeloperoxidase-ANCA seropositivity in 98%, including 39% with dual p-ANCA/myeloperoxidase-ANCA and cANCA/anti-protinase 3-ANCA positivity, often accompanied by anti-nuclear antibody (89%), anti-histone antibody (98%), and hypocomplementemia (58%). Kidney biopsy revealed necrotizing and crescentic glomerulonephritis, similar to primary ANCA-GN, but significantly less frequently pauci-immune (77 vs. 100%) and more commonly associated with mesangial hypercellularity (30 vs. 5%), electron dense deposits (62 vs. 20%), and endothelial tubuloreticular inclusions (11 vs. 0%); all significant differences. On follow-up, 42 of 51 patients received induction immunosuppression: 19 reached the combined end-points of kidney failure or death and 32 had mean creatinine of 1.49 mg/dL at last follow-up. Thus, hydralazine-associated ANCA-GN often exhibits overlapping clinical and pathologic features of mild immune complex glomerulonephritis resembling lupus nephritis. With discontinuation of hydralazine and immunosuppression, outcomes are similar to primary ANCA-GN.

Blood Lead Level and Renal Impairment among Adults: A Meta-Analysis.

Background: The adult population in lead-related occupations or environmentally exposed to lead may be at risk for renal impairment and lead nephropathy. This meta-analysis aims to determine the impact of blood lead level (BLL) on renal function among middle-aged participants. Methods: Cross-sectional, longitudinal, or cohort studies that reported BLL and renal function tests among adult participants were retrieved from PubMed, Scopus, and ISI Web of Science. Relevant studies were included and assessed for quality using the Newcastle–Ottawa Scale (NOS). The pooled mean BLL of participants with a high BLL (≥30 µg/dL), moderate BLL (20–30 µg/dL), and low BLL (<20 µg/dL) was estimated using the random effects model. The pooled mean differences in BLL, blood urea nitrogen (BUN), creatinine, uric acid, and creatinine clearance between the exposed and non-exposed participants were estimated using the random effects model. Meta-regression was performed to demonstrate the association between the effect size (ES) of the pooled mean BLL and renal function. Heterogeneity among the included studies was assessed using the Cochrane Q and I2 statistics. Cochrane Q with a p value less than 0.05 and I2 more than 50% demonstrated substantial heterogeneity among the studies included. Publication bias was assessed using the funnel plot between the effect size and standard error of the effect size. Results: Out of 1657 articles, 43 were included in the meta-analysis. The meta-analysis demonstrated that the pooled mean BLL in the participants with a high BLL, moderate BLL, and low BLL was 42.41 µg/dL (95% confidence interval (CI): 42.14–42.67, I2: 99.1%), 22.18 µg/dL (95% CI: 21.68–22.68, I2: 60.4%), and 2.9 µg/dL (95% CI: 2.9–2.9, I2: 100%), respectively. The mean BLL of the exposed participants was higher than that of the non-exposed participants (weighted mean difference (WMD): 25.5, p < 0.0001, 95% CI: 18.59–32.45, I2: 99.8%, 17 studies). The mean BUN (WMD: 1.66, p < 0.0001, 95% CI: 0.76–2.55, I2: 76%, 10 studies) and mean creatinine (WMD: 0.05, p = 0.007, 95% CI: 0.01–0.08, I2: 76.8%, 15 studies) in the exposed participants were higher than those in the non-exposed participants. The mean creatinine clearance in the exposed participants was lower than that in the non-exposed participants (standard mean difference (SMD): −0.544, p = 0.03, 95% CI: −1.035–(−0.054), I2: 96.2%). The meta-regression demonstrated a significant positive effect of BLL on BUN (p = 0.022, coefficient: 0.75, constant: −3.7, 10 studies). Conclusions: BLL was observed to be associated with abnormal renal function test parameters, including high BUN, high creatinine, and low creatinine clearance. Moreover, BUN seemed to be the most valuable prognostic marker for lead-induced renal impairment. Therefore, regular checks for renal function among lead-exposed workers should be a priority and publicly promoted.

Effect of Dyslipidemia Therapy on Creatinine Kinase Activity Level in Patients with Heart Disease

Cardiovascular disease remains a significant health problem in the Asia Pacific region. Several studies have found that dyslipidemia is a cause of morbidity and mortality and requires high medical costs. Dyslipidemia is a risk factor for atherosclerosis. The most widely used therapy for dyslipidemia is statins. Statins often cause muscle disorders such as myalgia, myopathy, and rhabdomyolysis, which can cause death. A prospective cohort study design was carried out at Airlangga University Hospital, Surabaya, from April to November 2019. A total of 26 sample pairs containing 13 samples were treated with Atorvastatin, and 13 samples were treated with Simvastatin. The subjects were examined for the creatinine kinase activity level using enzymatic methods. The mean creatinine kinase levels in the atorvastatin group before and after treatment was 105.71 IU/L and 100.03 IU/L, respectively, because the subjects were diagnosed with acute coronary syndromes and blood was collected during acute conditions. Median creatinine kinase levels in the Simvastatin group were 85.5 IU/L before therapy and 118.1 IU/L after therapy, indicating significant differences in creatinine kinase levels before and after treatment. Simvastatin is very susceptible to certain drug interactions that can increase the concentration of statins in the serum. There were differences in levels of creatinine kinase activity before and after Simvastatin therapy but not Atorvastatin.

POS-241 GLOMERULAR FILTRATION RATE AND FIRST NEPHROLOGY CONSULTATION IN THE ELDERLY

Chronic kidney disease (CKD) is a major predictor of mortality. Serum creatinine (Scr) is poorly reliable in elderly. Furthermore, Glomerular filtration rate (GFR) more than Scr guarantees for a set of clinically meaningful intervals.we aimed at investigating the relationship between GFR in the elderly and the delay of referral to nephrology consultation. This is a retrospective study concerning patients over 65 years presenting to the nephrology consultation of the Sahloul University Hospital in Tunisia during the year of 2017.We analyzed the demographic, clinical-biological parameters and the evolution of the renal function. In this study, 57 patients had advanced renal failure (GFR < 60 ml/min).They represented 13.7 % of new consulting patients during the year of 2017.In fact, one patient was referred at the first stage of CKD (GFR = 92 ml/min) and four patients were referred at the second stage of CKD (60<= GFR <89 ml/min). The other patients have been seen at stages 3, 4 and 5 of CKD in respectively 43.5%, 32.3% and 16.1% of cases.Mean age was 74 ± 6 years (65–89 years). Proportion of very old patients (>= 80 years) was 21.1 %. There were 28 males and 29 females (a sex ratio of 0.96). Patients were referred to the consultation by a general practitioner in 32% of cases.These patients had other comorbidities in 98.2% of cases dominated by hypertension, diabetes, dyslipidemia, heart diseases and urologic diseases in respectively 91.2%, 49.1%, 31.6 %, 31.6 % and 28.1% of cases. They were taking nephrotoxic treatment in 42% of cases which were treatment altering the hemodynamic of kidney, iodine contrast agents and Nonsteroidal anti-inflammatory drugs in respectively 64.9 %, 17.5 % and 17.5 % of cases. These patients benefit from a renal biopsy in less than 5 % of cases. The mean creatinine at the first visit was 27.13 mg/l and this correspond to a GFR of 30.19 ml/min. The mean Proteinuria was 0.9 g/24h.The number of consultations during one year was 4 consultations per year on average. The evolution over 2 years was marked by improvement and/or stabilization of renal function, worsening of renal function, starting dialysis, death in respectively 42.1%, 3.5%, 10.5% and 7% of cases. In 7 % of cases, the patients were referred to their general practitioners and in 36.8% they were lost to follow-up. This study highlights that elderly patients with CKD are referred to the nephrology consultation tardily. We suggests that their care should be managed by nephrologist in earlier stage. Therefore, Collaboration between general practitioners and specialists makes it possible to provide better care for this population.

POS-449 ADULT ONSET MINIMAL CHANGE DISEASE: CLINICAL CHARACTERISTICS, TREATMENT AND PROGNOSIS

Minimal change disease (MCD) is an uncommon glomerulopathy in adults, accounting for almost 15 to 20% of nephrotic syndrome (NS) unlike children in whom MCD is the most common cause of NS accounting for almost 80 % of cases. Most MCD patients respond well to steroids and have a preserved renal function. However, MCD remains a therapeutic challenge for the nephrologist especially for frequently relapsing, steroid dependent, and steroid resistant NS.This study aimed to describe characteristics and outcomes of adult patients with MCD. This is a retrospective study including adult patients having NS with biopsy proven MCD from January 2006 to December 2019 in a nephrology department. Were collected all patients’ characteristics including clinical, biological, histological and etiological features, as well as therapeutic and prognostic outcomes. 66 adult patients with biopsy proven MCD were analyzed. 56% were male. Mean age at presentation was 35.8±15.18 years. At diagnosis, all patients had edema. 9.09% patients had hypertension. 14.3% patients had microscopic hematuria. 12.12% patients had acute renal failure. Mean creatinine was 88,54±46,34 µmol/L. Mean daily proteinuria was 8.39±4.9 g/l. 74.6% patients had a pur NS. In biopsy, 6.06% patients had particularly mesangial proliferation and 12.1% had IgM deposits. Secondary causes of MCD were seen in 21.2% of cases (atopy in 78.6% and drugs in 21.4%). 6.25% patients had spontaneous remission. Remission rate was 93.3% but 69.3% patients had relapsed. 4.16% patients were frequent relapsers, 20.8% were steroid dependent and 6.25% were steroid resistant. Immunosuppressive therapy was needed in 6 patients. 14.58% patients had chronic renal failure and 2 progressed to end-stage renal disease. Patient survival was of 95.8% at 13 years. Relapses of MCD are common in adults and their treatment is challenging. However MCD remains a benign lesion with a good long-term prognosis and few patients progressing to end-stage renal disease.

PRESENTATION, MANAGEMENT, AND OUTCOME OF POSTERIOR URETHRAL VALVES IN WESTERN RAJASTHAN

Introduction: Posterior urethral valve (PUV) is the most common cause of bladder outlet obstruction and renal insufciency in male children. The aim of this study was to evaluate the presentation, management, challenges, and outcome of the disease in a Western Rajasthan tertiary health institution. Methods: In a retro-prospective study, 26 male children were included from November 2017 to March 2020 at Dr. S.N.Medical college, Jodhpur. Diagnosis was conrmed by voiding cysto-urethrography (VCUG). Results: A total of 26 patients were managed for PUV.The mean age of presentation was 3.45 years with 65.8% of the patients presenting after 1 year. Voiding dysfunction noted in 23(88.4%) patients was the most common presentation. Most common nding on physical examination was palpable bladder 15(57.6%) while UTI noted in 15 (57.6%) patients was most common complication. Abdominal sonography revealed dilated posterior urethra in 10(38.4%) cases, while VCUG revealed a dilated posterior urethra in 19 (75%) cases.The creatinine value at presentation ranged from 0.4-4.5 mg/dl with a mean of 1.10 ± 0.95 mg/dl. Valve ablation with a diathermy bugbee electrode &amp; holmium laser provided relief of obstructions in the 23 (88.4%) patients who underwent the procedure without immediate complication. The period of follow-up ranged between 1 weeks to 2 years with a mean of 8.2 months. There was sustained improvement in urine stream, reduction in the mean creatinine concentration and incidence of UTI during follow-up. Conclusion: Many patients with PUVpresented late within the reviewed period. Valve ablation provided relief of obstruction in most of the cases. Efforts at improving awareness among general population and early diagnosis and referral among the health team should be encouraged. There is a need to counsel parents on the need for long-term follow-up

POS-009 PREVALENCE AND ETIOLOGIES OF ACUTE KIDNEY INJURY IN ELDERLY

Acute renal failure in the elderly is a common phenomenon. It is favored by functional modifications of the kidney and the repercussions of many chronic diseases such as diabetes, hypertension or obstructive urological pathologies which incidence increases with age. The aim of our work was to study the epidemiological and clinical characteristics, to specify the etiological circumstances and the different therapeutic and evolutionary modalities of AKI in the elderly. It was a retrospective descriptive study conducted on 70 AKI files identified in the Nephrology department of Charles Nicolle Hospital in Tunis among 380 patients hospitalized over a period of one year. The incidence of AKI in the elderly was 44.8%. It was classified AKIN 1, 2 and 3 in 25%, 25.6% and 49.4% of cases, respectively. The average age was 75 years. The sex ratio was 1.12. The pathological history was dominated by cardiovascular pathology. High blood pressure and diabetes were noted in 56% and 32% of the cases, respectively. Patients were hospitalized through the emergency room in 47.1% of the cases or outpatient in 14.3% of the cases. The discovery of AKI was systematic in the face of an increase in serum creatinine and / or urea numbers in 60% of cases. Signs of acute uremia and changes in diuresis revealed ARI in 57.1% and 30% of the cases, respectively. The mean creatinine level was 515 μmol / l. Hypokalemia and hyperkalemia were observed in 14.4% and 21.4% respectively. AKI was organic in 42.8% of the cases, functional in 31.8% of the cases and related to an obstacle in 24.8% of the cases. Correction of hydroelectrolytic disorders was performed in 61.4% of our patients. Diuretics were used in 17.4% of patients. Hemodialysis was performed only in 18% of our patients. It was performed prophylactically in 7 cases and in an emergency context in 6 cases. In the latter case, the indication for hemodialysis was primarily hyperkalemia and / or metabolic acidosis. The average hospital stay was 19 days. The evolution was favorable in 64.2% of the cases, unfavorable in 35.8% of the cases with a passage to chronicity in 32.6% and a death in 12.8% of the cases. In the elderly, acute renal failure is a common morbid event. The structural and functional alterations of the nephron and the increase in the incidence of certain pathologies expose these patients to nephrotoxic accidents. Hence the interest of preventive measures of this AKI and especially the importance of an early diagnosis based on new biomarkers of AKI, in order to establish the most suitable therapeutic means.

POS-090 PRIMARY HYPERPARATYHROIDISM: A NEPHROLOGIST EXPERIENCE

Primary hyperparathyroidism (PHPT) is a common endocrine disorder frequently encountered in everyday practice. It classically presents with hypercalcemia which is the hallmark of the disease in association with inappropriately normal to high levels of PTH . The clinical presentation may vary from asymptomatic to symptomatic disease with eventual complications, for instance skeletal and renal abnormalities. It may be due to a single benign parathyroid adenoma which is by far the most common cause or a multiglandular disease in the familial forms Herein is a retrospective and descriptive single-center study of PHPT observed among patients between 2010 and 2020 realized in our department of nephrology in Monastir Tunisia. 10 patients were gathered. The mean age was 58.5 years ranging from 27 to 87 years . The sex ratio was1 :1. Hypertension was found in 5 patients (50 %) : 3 females and 2 males. 1 patient was found to have diabetes. Lithiasis occured in 3 patients all of whom were women and nephrocalcinosis occured in 2 patients. There were no vascular calcifications nor pain in any patient. The average hemoglobin was 9.2 g/dl ranging from 8 to 11.3 g/dl. All patients had hypercalcemia with a mean of 3.09 mmol/l. 5 patients had hypophosphatemia (50 %). PAL was available in 5 patients all of whom had elevated levels with a mean of 190.8 UI/ml. The mean creatinine level was 196.2 umol/l. Cervical ultrasound was performed in all patients and came back normal in 6 patients (60%). In the remaining patients, it has shown bilateral or unilateral lobules. Scintigraphy was also performed in all patients and findings were consistent with those found in the 4 patients with ultrasound abnormalities but has shown anomaly in 4 of the 6 patients (66%) in whom ultrasound came back normal. One patient had developed a brown tumor. Total parathyroidectomy was performed in 6 patients and partial parathyroidectomy in 2 patients. In the post-operative follow-up, all of the patients have normalized their calcemia levels , 5 patients have normalized their kidney function (50%) and the diagnosis of acute kidney injury secondary to hypercalcemia was retained. PHPT affects women 3 to 4 times more than men but in our study they were similar. Hypercalcemia was the most important biological sign.