Mean Serum Creatinine Level Research Articles

Pattern and Frequency of Microalbunuria with Different Types of Stroke

Introduction with aim and objectives: Cerebrovascular diseases have recently emerged as a major health problem affecting the elderly population. The spectrum includes some of the most common and devastating disorders like ischemic stroke, hemorrhagic stroke and anomalies in vascular system. Microalbuminuria is an early finding in urine in the patients of diabetes and hypertension and it is associated with macrovascular complications like cerebrovascular accident and myocardial infarction. The aim of this study was to find out the pattern and frequency of microalbunuria with different types of stroke. Materials and Methods: Fifty cases of stroke Patients admitted in CMCH medicine and neurology department from 1 January 2019 to 31 June 2019 were analyzed and urine for microalbumin was done. Univariate statistical analyses were performed to see the outcome in relation with blood volume by SPSS-19. Results: Regarding analysis of gender distribution of 50 study patients, 27(60%) were found male and 23(40%) were found female. Male to female ratio was 1:0.4. Among the 50 patients, different types of occupation were found. House wife was common occupation. Among the total patients, most of them were from lower middle class 24(61.4%). Others were from low 16(32.0%) and upper middle class 10(5.75%) group. Most of the patients were from rural residence 41(80%). In our study, 13(71.42%) patients had hypertension. Diabetes mellitus was found among 13(8.57%). Different examination findings were analyzed where mean GCS of ischaemic stroke was 14.5 and mean GCS of hemorrhagic stroke was 10.6, 12 patients had abnormal fundoscopic findings. Regarding analysis of serum LDL and serum Creatinine, mean LDL level was 123.95 and mean serum Creatinine level was 1.19. After analysis, mean of urine for Microalbumin of 30 Ischaemic stroke patients was 71.96mg/L and mean of urine for Microalbumin of 20 Hemorrhagic stroke patients was 80.70mg/L. Conclusions: We found high frequency of microalbuminuria in patients with stroke Therefore; microalbuminuria could be is a useful modifiable factor, in addition to conventional risk factors, in identifying those at increased risk of stroke. Medicine Today 2023 Vol.35(1): 63-66

Is the Presence of 2 Renal Allograft Arteries Associated with Adverse Outcomes in Live Donor Kidney Transplantation?

Although it was postulated that renal grafts with multiple arteries could lead to unfavorable recipient outcomes, this subject remains controversial. This study aimed to compare the outcomes of recipients receiving renal allografts with a single artery with those receiving renal grafts with two arteries. Adult patients who received live donor kidney transplantation in our center between January 2020 and October 2021 were included. Data including age, gender, body mass index, renal allograft side, pre-kidney transplantation dialysis status, human leukocyte antigen mismatch number, warm ischemia time, the number of renal allograft arteries (single/double), complications, duration of hospitalization, postoperative creatinine levels, glomerular filtration rates, early graft rejection, graft loss, and mortality were collected. Subsequently, patients who received single-artery renal allografts were compared with those who received double-artery renal allografts. Overall, 139 recipients were included. The mean recipient age was 43.73 ± 13.03 (21-69). While 103 recipients were male, 36 were female. The comparison between the 2 groups revealed that mean ischemia time was significantly longer in the double-artery than in the single-artery group (48.0 vs. 31.2 minutes) (P=.00). In addition, the single-artery group had significantly lower postoperative day 1 and day 30 mean serum creatinine levels. Also, the mean postoperative day 1 glomerular filtration rates were significantly higher in the single-artery group than in the double-artery group. However, the 2 groups were similar concerning the glomerular filtration rates measured at other times. On the other hand, there was no difference between the 2 groups regarding duration of hospitalization, surgical complication, early graft rejection, graft loss, and mortality rates. The presence of 2 renal allograft arteries does not have adverse effects on the postoperative parameters of the kidney transplantation recipients, including graft function, duration of hospitalization, surgical complication, early graft rejection, graft loss, and mortality rates.

PREGNANCIES IN KIDNEY TRANSPLANT RECIPIENTS, AN ANALYSIS OF 9 CASES

(Objective) Pregnancy in kidney transplant recipient continues to remain challenging due to a high rate of cesarean section along with preterm delivery, and concern for worsening renal function. This study examined the prognosis and perinatal management of post-transplant pregnancies. (Patients and methods) A total of nine post-transplant recipients at Niigata University Medical and Dental Hospital between 2007 and 2021 were retrospectively examined. (Results) All pregnancies were planned. Calcineurin inhibitors and steroids were continued, and antimetabolites were changed to azathioprine. The mean age at delivery was 33±3.8 years, and the mean time from renal transplantation to delivery was 6.5±3.5 years. Five patients (55.5%) had cesarean sections, while four (44.5%) patients had normal vaginal deliveries. The mean gestational age was 35±3.0 weeks, and the mean birth weight was 2,336±565.4 g. No congenital malformation was observed. The most common reason for early delivery was worsening renal function, seen in six (66.7%) patients. The mean serum creatinine level before pregnancy was 1.11±0.23 mg/dL and then worsened to 1.59±0.37 mg/dL during pregnancy. However, it recovered to 1.14±0.40 mg/dL after delivery. One patient had antibody-mediated rejection with donor specific antibody (DSA) prior to pregnancy, and her renal graft function worsened slightly after delivery. Another patient had a de novo DSA after delivery, which was not detected before pregnancy. (Conclusions) In our hospital, pregnancy in kidney transplant recipients were safe and renal graft function after delivery was relatively stable. Patients may require adjustment of calcineurin inhibitors during pregnancy, and the appearance of DSA after delivery should be noted.

Therapeutic effect of amlodipine versus benidipine in the management of essential hypertension – A comparative study

Background: Hypertension is a significant risk factor for atherosclerotic diseases. Calcium channel blockers (CCBs) are extensively used in hypertension treatments that effectively reduce blood pressure. The dihydropyridine category of CCBs, which includes amlodipine and the new generation CCB benidipine, has shown the best outcomes. Aims and Objectives: The aims of the study were to compare the effectiveness of amlodipine and benidipine in treating uncomplicated hypertension in patients visiting tertiary care facilities. Materials and Methods: A source of 134 participants of both genders diagnosed with uncomplicated hypertension with blood pressure ≥140/90 mm Hg, between 21 and 65 years of age were recruited. Participants were randomly allocated and treated with amlodipine 2.5 mg for Group A and benidipine 4 mg once a day in the morning. Details of ankle edema were collected and serum creatinine and urine albumin data were recorded at baseline, 6 weeks, and 12 weeks. Results: The ankle edema was observed in 35.82% of cases in Group A and 10.44% in Group B. The mean serum creatinine level was 0.92 mg/dl in Group A and 0.87 mg/dl in Group B. The mean systolic blood pressure (SBP) was 151.7 mm Hg and 153.9 mm Hg at baseline, which was reduced to 132.58 mm Hg and 128.44 mm Hg after drug therapy in Groups A and B, respectively. The mean diastolic blood pressure was 97.14 mm Hg and 98.96 mm Hg before therapy, which was reduced to 82.4 mm Hg and 82.2 mm Hg after therapy, respectively. Conclusion: Amlodipine and benidipine are similarly effective antihypertensive medications on their own. However, compared to the amlodipine-treated group, the benidipine-treated group displayed a significant reduction in the mean difference in SBP.

Comparing Estimated and Measured Glomerular Filtration Rate in Children with Posterior Urethral Valve.

Posterior urethral valve (PUV) is obstructive uropathy that may lead to chronic kidney disease (CKD) and end-stage renal disease (ESRD) in children. Glomerular filtration rate (GFR) measurement remains the gold standard for renal function measurement. However, due to its less availability and cumbersome, it is not commonly used, and GFR is estimated utilizing various endogenous filtration markers. This study includes pediatric patients with PUV. We aimed to compare the measured GFR (mGFR) with various creatinine-based estimated GFR methods (eGFR). A single-center retrospective study included 62 treated cases of PUV, postvalve fulguration. The mGFR measured by 99mTc-diethylenetriaminepentaacetate in vitro method and compared with eight eGFR (Schwartz, Cockcroft-Gault [CG], Counahan-Barratt [CB], CKD Epidemiology Collaboration [CKD-EPI], full-age spectrum [FAS] age, FAS height (FAS Ht), Schwartz-Lyon [SL], and Ht independent). Patients were subdivided into different CKD grades and compared with various eGFR. PUV is a common cause of CKD in children and needs special consideration as there is growth retardation associated with it. It decreases creatinine production and thus fallacies in eGFR measurement. There is a requisite to identify and closely monitor the subset of patients with baseline decreased renal function and therefore at risk of developing ESRD. A total of 62 patients were included. Mean age and serum creatinine levels were 8.02 ± 5.53 years and 1.15 ± 0.95 mg/dl (range: 0.4-4.5), respectively. The mean mGFR was 61.6 ± 31.80 mL/min/1.73 m2 and a positive variable correlation was 0.46-0.77 between mGFR and eGFR. Based on mGFR, there were 14 (22.6%), 21 (33.8%), 13 (20.9%), 9 (14.5%), and 5 (8.1%) patients in Grades I-V, respectively. The correct classification of the CKD grades was noted in 25 (40.3%), 16 (25.8%), 32 (51.6%), 16 (25.8%), 25 (40.3%), 27 (43.5%), 26 (41.9%), and 28 (45.2%) patients by Schwartz, CG, CB, CKD-EPI, FAS age, FAS Ht, SL, and Ht-independent equation. The eGFR overestimates GFR at the lower level and underestimates at higher levels. Our results confirm the considerable limitations of various creatinine-based clearance methods for estimating actual GFR. The creatinine clearance-based eGFR should not replace the measurement of the GFR. An initial measure of the mGFR followed by serial follow-up with the eGFR equation may be done. The most accurate eGFR equations are CB for Grade II, SL or Ht independent for Grade III, FAS age for Grade IV, and SL for Grade V CKD.

Vitamin D Status in Patients with Renal Disorders at a Tertiary Care Hospital in Coimbatore, Tamil Nadu, India: A Cross-sectional Study

Introduction: Patients with renal disorders often have insufficient levels of vitamin D. One of the key enzymes involved in activating vitamin D, 1-α hydroxylase, is present in the kidneys. As a result, patients with kidney diseases are more susceptible to developing vitamin D deficiency, which can increase mortality and morbidity in these patients. Additionally, variations in lifestyle and culture can contribute to geographical differences in baseline serum vitamin D levels. Aim: To evaluate and compare serum vitamin D levels in patients with various renal disorders. Materials and Methods: This retrospective cross-sectional study was conducted in the Department of Biochemistry at the KMCH Institute of Health Sciences and Research Centre in Coimbatore, Tamil Nadu, India from August 2018 to August 2019. Data from 269 patients were collected from the Medical Records Department (MRD) using a predefined data collection tool. All patients with renal disease, regardless of disease severity, who had serum vitamin D levels measured during the study period were included. The collected data included age, gender, height, weight, Body Mass Index (BMI), dietary history, diagnosis, serum vitamin D3 levels, and serum creatinine levels. The data were statistically analysed using Analysis of Variance (ANOVA) and Pearson’s correlation coefficient. Results: Among the study participants, 148 were males and 121 were females, with a mean age of 54.12±17.43 years. The mean vitamin D3 level in the study population was 20.8 ng/mL. The mean serum creatinine and urea levels were 2.2±1.1 mg/ dL and 63.2±42.1 mg/dL, respectively. The mean estimated Glomerular Filtration Rate (eGFR) was 41.4±25.34 ml/min/1.73 m2. The mean serum calcium, phosphate, and uric acid levels were 5.8±2.65 mg/dL, 2.16±0.87 mg/dL, and 3.6±2.3 mg/dL, respectively. One-way ANOVA showed no significant difference in serum vitamin D3 levels among patients with different renal diseases (F=0.473, p=0.854). Pearson’s correlation analysis revealed no significant correlation between serum vitamin D3 levels and any other parameters. Conclusion: In present study, only 23% of patients had vitamin D levels within the normal reference range, 22% had insufficient vitamin D levels, and 55% had vitamin D deficiency. No significant difference in vitamin D levels was observed among patients with different renal diseases.

Evaluation of Serum Creatinine and Serum Uric Acid In Hypothyroid Patients: A Cross-sectional Study

Introduction: Hypothyroidism, a prevalent endocrine disorder, leads to a generalised metabolic slowdown due to insufficient thyroid hormone production, potentially resulting in elevated levels of serum uric acid and creatinine, thus affecting renal function and purine metabolism. Aim: To assess serum creatinine and serum uric acid levels in hypothyroid patients while establishing correlations with their thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) levels. Materials and Methods: A comparative cross-sectional study was conducted in the Department of Biochemistry, Government Medical College, Kozhikkode, Kerala, India. The study involved 140 participants, including 70 recently diagnosed hypothyroid patients and 70 age- and sex-matched euthyroid individuals. Thyroid hormone levels (FT3, FT4) and TSH were quantified using the Cobas e411 electro-chemiluminescence technique. Serum creatinine levels were measured using the Modified Jaffe’s method, and serum uric acid levels were assessed through the Uricase method (Enzokit). Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21.0, and tables and graphs were generated using Microsoft Word and Excel. Results: The mean age of study participants of control group was 39.02 years and of the hypothyroid group was 36.80 years. The comparative cross-sectional analysis revealed significantly higher levels of serum uric acid and serum creatinine in hypothyroid patients compared to euthyroid controls. Specifically, hypothyroid patients exhibited a mean serum uric acid level of 10.77±2.34 mg/dL, while euthyroid controls had a mean of 4.37±0.94 mg/dL. Mean serum creatinine levels for hypothyroid patients and euthyroid controls were 2.16±0.80 mg/dL and 0.75±0.14 mg/dL, respectively. Notably, a significant positive correlation was observed between serum uric acid and serum creatinine levels with TSH (r=0.42, p-value<0.001 and r=0.45, p=0.00, respectively). Conclusion: The study identified significantly higher levels of serum uric acid and creatinine in hypothyroid patients compared to euthyroid individuals, potentially attributed to haemodynamic changes and disruptions in purine metabolism. Regular monitoring of these parameters is crucial for individuals with hypothyroidism.

Efficacy of gonadotropin-releasing hormone antagonists in the management of patients with severe early-onset ovarian hyperstimulation syndrome

Objective. To study the efficacy of gonadotropin-releasing hormone (GnRH) antagonists in the treatment of patients with severe early-onset ovarian hyperstimulation syndrome (OHSS). Patients and methods. This study including 60 women was conducted between January 2021 and January 2023 at Al-Azhar University Maternity Hospitals and private ART centers. Approval from the Research Ethics Committee was obtained to conduct the study. Patients were randomly divided into two groups: group I (n = 30; control group) received only standard therapy for severe OHSS, group II (n = 30; study group) received standard therapy and cetrorelix. Results. The percentage of patients who required paracentesis, the mean serum creatinine level 48 hours after GnRH antagonist injection, and the percentage of patients who had persistent oliguria 48 hours after GnRH antagonist injection were significantly lower in the study group (cetrorelix group) compared with the control group. Patients in the cetrorelix group had a significantly shorter mean length of hospital stay and mean recovery time than patients in the control group. Conclusion. The therapeutic efficacy of the GnRH antagonist cetrorelix for the treatment of patients with severe early-onset OHSS was demonstrated. Key words: gonadotropin releasing-hormone antagonist; severe early-onset ovarian hyperstimulation syndrome

Böbrek nakli hastalarında biyopsi ile kanıtlanmış BK virüs nefropatisi: risk faktörleri, sıklığı ve tedavi yaklaşımı

Purpose: BK virus nephropathy (BKVN) is a latent infection and it is closely associated with immunsuppressive therapy. We aimed in this study to evaluate biopsy-proven BKVN and investigate frequency, risk factors and treatment management. 
 Materials and Methods: In this study, 422 kidney transplant recipients were analysed retrospectively between April 2014 and April 2020 for biopsy-proven BK virus nephropathy. Group I included 16 kidney transplant patients with biopsy-proven BK nephropathy and group II included 36 kidney transplant patients with negative BK virus nephropathy. We aimed demographic, clinical features of kidney transplant recipients with BKVN (group I, n: 16 ) and non-BKVN (group II, n:36) were compared and the factors affecting of BKVN. 
 Results: The mean age of grup I and group II were were 41±14.8 years and 39±15.2 respectively. The patients mean follow-up period of 43±11.2 months. Serum creatinine and proteinuria degree were significantly higher in the group with BKVN. In order to reduce the dose of immunosuppression in patients with BKVN, tacrolimus treatment was discontinued in 8 patients, and they were switched to everolimus + MMF + prednisone treatment, leflunamide + MMF + prednisone treatment in 4 patients, and sirolimus + MMF + prednisone treatment in 4 patients. The mean serum creatinine level of the patients who were followed up were observed as 1.78±0.98 mg/dl in group I.
 Conclusion: In our center, the prevalance of BKVN was found 3.92% during the study period. Reduction of dose immunosuppressive therapy is the most effective treatment. It is thought that there was no differences between Leflunamide and other approaches for treatment. Early diagnosis and screening (frequently intervals) seems to be most effective way for BKVN.

A Prospective Study of Pressure Injury Healing Rate and Time and Influencing Factors in an Acute Care Setting.

To determine pressure injury (PI) healing rate and time and identify influencing factors. A prospective cohort research design was used. Data collection was performed between May 2015 and August 2018. The study participants were 77 inpatients who developed at least one PI during their stay in a university hospital. Researchers assessed participants' demographic (age, sex); physical (incontinence, activity of daily living, and nutrition status); physiologic (serum total protein, albumin, and creatinine, blood glucose, and hemoglobin levels); and disease- (diagnosis, number of comorbidities, and cardiovascular comorbidity), wound- (PI stage and size at first detection, and Pressure Ulcer Scale for Healing score), and treatment-related (IV nutrition supply and albumin infusion) factors. Across the 77 patients, 91 PIs developed. Of these, 54 (59.3%) healed with a mean healing time of 17.63 days. The healing rate was better, and the healing time was shorter for stage 2 PIs compared with unstageable or deep-tissue PIs. Factors influencing PI healing rate were number of comorbidities, cardiovascular comorbidity, incontinence, PI stage at first detection, IV nutrition supply, and mean serum creatinine level. Factors influencing PI healing time were number of comorbidities, cardiovascular comorbidity, and PI stage at first detection. To reduce hospital stays, PI-related complications, and mortality, evidence-based management strategies for PIs are needed. The findings of the present study may contribute to the development of such strategies.

Prognostic value of serum levels of multiple adhesion factors in patients with sepsis-induced acute kidney injury

BackgroundAcute kidney injury (AKI) is common in patients with sepsis and septic shock. Urine output and serum creatinine (SCr) levels are the criteria for diagnosing AKI. However, the application of these levels in the diagnosis of AKI has limitations.ObjectiveTo detect the expression of various adhesion factors in different stages of AKI as defined by Kidney Disease: Improving Global Outcomes (KDIGO) and to analyse their relationship with the prognosis of patients with sepsis-induced AKI (S-AKI).MethodsAdult patients with sepsis who were admitted to the hospital between June 2019 and May 2020 were included. Of 90 adult patients with sepsis, 58 had S-AKI. Sixty-seven subjects without sepsis were used as controls. Enzyme-linked immunosorbent assay kits were used to measure E-selectin (CD62E), L-selectin (CD62L), P-selectin, intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1), and their relationship with the prognosis of patients with S-AKI patients was analysed. Receiver operating characteristic curves were used to analyse the predictive value of different adhesion factors on renal resistance index and renal function recovery. Multivariate logistic regression analysis was used to identify factors associated with renal recovery.ResultsThe expression of CD62L was significantly higher in S-AKI patients than in non-AKI patients with sepsis. Compared with the non-AKI group, Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were significantly higher in the AKI group than in the non-AKI group (P < 0.05). Mean blood pressure, SCr levels and procalcitonin levels were higher in the AKI group than in the non-AKI group (P < 0.05 for all). The CD62L levels decreased with increasing S-AKI stage. The CD62E levels were highest in S-AKI stage 2, and the VCAM-1 levels were highest in S-AKI stage 3. All patients with S-AKI were followed up with for 28 days. The results found that VCAM-1 was the best predictor of renal recovery in patients with S-AKI.ConclusionCD62L is an indicator of S-AKI stage1, and CD62E is an indicator of S-AKI stage 2. In addition, VCAM-I demonstrated satisfactory performance in predicting early recovery of renal function in patients with S-AKI.

A Study of Serum Creatinine and Urea in Adult Female Individuals and their Correlations with BMI

Background: The World Health Organization has announced overweight and obesity as a global epidemic that has strong associations with renal function impairment.&#x0D; Objectives: To evaluate the serum creatinine and urea status in adult female individuals with previous normal renal function and to observe the correlation of serum creatinine and urea with body mass index (BMI).&#x0D; Methods: This cross-sectional analytical study was conducted in the Department of Physiology, Rangpur Medical College, Rangpur. After briefing about the objectives, adult female subjects who met the inclusion and exclusion criteria were enrolled in the study with permission. The study included 90 subjects who were divided into three groups- apparently healthy adult females with normal weight (Group-A), apparently healthy overweight adult females (Group-B), and apparently healthy obese adult females (Group-C). The subjects were selected from different areas of Rangpur city. Their body mass index, serum creatinine, and urea were measured. For statistical analysis, one way ANOVA (post-Hoc) test and Pearson’s correlation coefficient test were performed as applicable by computer-based SPSS-25.0 for windows. Regarding the interpretation of results, p_0.05 was accepted as significant.&#x0D; Results: The mean serum creatinine level was significantly (p_0.001) higher in overweight and obese female adults than in normal-weight female adults. It was also significantly (p_0.05) higher in obese female adults than in overweight female adults. Again, the mean serum urea level was significantly (p_0.05) higher in overweight female adults than normal-weight female adults and in obese female adults than in overweight female adults. It was also significantly (p_0.001) higher in obese female adults than in normal-weight female adults. This study also found highly significant (p_0.001) positive correlation of serum creatinine (r=0.499) and urea (r=0.396) with body mass index.&#x0D; Conclusion: Serum creatinine and urea were elevated in overweight and obese female adults and both parameters were positively correlated with BMI. Regular body mass index screening is recommended to assess body weight easily and effectively.&#x0D; J Rang Med Col. September 2022; Vol. 7, No. 2:25-30

Histopathologic and clinical features of diabetic nephropathy alone and with concomitant nondiabetic renal diseases

Background and objective: Diabetic nephropathy (DN) is a major complication of diabetes mellitus (DM) and one of the leading causes of end-stage kidney disease. The aim of the present study was to evaluate the histomorphological and clinical profiles of DN and associated non-diabetic renal dieases (NDRD) in diabetic patients. Materials and methods: The study was carried out at the Department of Histopathology, Armed Forces Institute of Pathology (AFIP), Dhaka, from July 2019 to December 2020. Renal biopsy samples from known diabetic patients were included in the study. The formalin-fixed tissues were stained with haematoxylene &amp; eosin (H&amp;E), Periodic acid Schiff (PAS), Masson Trichrome (MT) and Jones Methanamine Silver (JMS) stains. Tissues were stained for IgG, IgA, IgM, C3, C1q, kappa and lambda for direct immunofluorescence (DIF) study. DN was histologically classified according to Tervaert classification system. Interstitial fibrosis and tubular atrophy (IFTA) as well as arteriolar hyalinization scoring was also done. Clinical information was retrieved from the patient’s information sheet. Results: Total 46 biopsy samples from DN cases were included in the study. The mean age of the cases was 46.76+10.63 years, including 36 males and 10 females. The most common clinical presentation was nephritic range proteinuria (n=32, 69.56%). Among all, 27 (58.69%) patients had haematuria. The mean serum creatinine level was 4.28+2.61 mg/dl, and 80.43% had serum creatinine levels &gt;1.5 mg/dl. Histopathologic examinatiom revealed type III DN in 26 (56.5%) and type IV DN in 11 (23.9%) cases. IFTA score 1 (&lt;25%) was seen in 20 (43.5%), score 2 (25-50%) in 19 (41.3%) and score 3 (&gt;50%) in 7 (15.2%). Vascular hyalinization score-2 in 25 (54.3%), score-1 in 14 (30.4%) and score-0 in 7 (15.2%). DN class II, III and IV were associated with high urinary total protein (UTP) and serum creatinine levels. Among the histologic changes, percentage of glomerular sclerosis, the mean IFTA score and vascular hyalinization score were found to be highest in class IV DN, and all were significantly associated with histologic glomerular DN classes (p= &lt;0.05). Of the total cases, 21 (45.65%) were found with nondiabetic renal diseases (NDRD), the most common feature was focal segmental glomerulosclerosis (FSGS) (26.57%), followed by IgA nephropathy and post-infectious glomerulonephritis (PIGN). Among 46 cases, one post-transplant biopsy was included, which revealed class II DN along with features of calcineurin inhibitor toxicity. Conclusion: Tervaert’s histologic classification of our cases revealed class III DN lesions as the predominant one, and the classes had a significant association with age of the patient, serum creatinine level, mean IFTA, arteriolar hyalinization and NDRD. Among the NDRD, FSGS was the most common pathology. IMC J Med Sci. 2023; 17(1): 003. DOI: https://doi.org/10.55010/imcjms.17.003 *Correspondence: Sk Md Jaynul Islam, Department of Histopathology, Armed Forces Institute of Pathology, Dhaka Cantonment, Dhaka, Bangladesh. Email: jaynul.islam@gmail.com

P9.07: Post Liver Transplantation Renal Impairment: Experience With the First 100 Cases in a Single Center in Mongolia

Introduction: Renal impairment is multifactorial complication of liver transplantation (LT) with a variable prevalence that depends on pretransplant comorbidities, degree and cause of ESLD, intra and postoperative variables. Predisposing factors and incidence haven’t been studied in emerging transplant centers. In this study we aimed to identify risk factors and incidence of post-LT renal impairment in the first 100 LT cases in an emerging transplant center. Methods: This was a single center retrospective case-control study of 100 adult patients who underwent LT from September 2011 to September 2020. Renal impairment was defined as a KDIGO stage III or IV. Creatinine and GFR were measured pre-transplantation, intraoperatively and post LT. Cases and controls were compared to identify risk factors. Evaluated variables included demographics, etiology of liver disease, MELD preexisting HTN and DM, ischemic time, donor/graft type, intraoperative hemodynamics, use of blood products and postoperative outcomes. Data was collected by survey and statistical processing and analysis was done with Microsoft Excel, SPSS 15.0 software. Results: Thirty-nine patients in the study had renal impairment, 28 were males (72%) with a mean age of 43y (35-52) with a BMI of 24.7, mean MELD of 14.2 and a class B CPT score in (53.8%). The most common etiology in this group was viral (67%) 10.8% had HTN and preTx diagnosis of DM (compared with 3.7% and 7.4% of the control group). 91% of the total study group were RL LDLT with GRWR, median (IQR) of 1.04 % (0.92-1.21). Tacrolimus+MMF was used in 92% of all cases. (94.8% of study group NS p=0.253). The mean serum creatinine level before liver transplantation was 0.70 ± 0.27 mg/dl, and glomerular filtration rate was 121.6 ± 61.3 ml/min/m2. Average creatinine level of recipients who had renal impairment after liver transplantation was 0.825 ± 0.24 (p= <0.001), and glomerular filtration rate was 111 ± 36.3 ml/min/m2 (p=<0.001). Other variables, like diagnosis, degree of disease, preexisting comorbidities, donor/graft type, intraoperative hemodynamics immunosuppression and postoperative outcomes were not statistically significant. Conclusions: Our data shows that there is a statistically significant correlation between high pre-transplant serum creatinine levels, low glomerular filtration rate and post-transplant renal impairment. This correlates with experienced centers results, showing that emerging transplant centers have similar rates, understanding that our MELD scores are on average lower than larger series. There was a higher number of patients in the study group with HTN and DM, that said this was not statistically significant. The main limitation of the study is related to sample size but as our rate of LT continues to grow significantly every year, we will continue to asses variables and modify these factors to improve the rate of kidney dysfunction.

Pregnancy in patients with stage 3-5 CKD: Maternal and fetal outcomes.

To investigate pregnancy outcomes and the effects of pregnancy on kidney function in patients with stage 3-5 chronic kidney disease (CKD). This was a retrospective study. The clinical data of women with pregnancies complicated by stage 3-5 CKD who delivered in the Peking University First Hospital from January 1st, 2013, to December 31st, 2020, were analyzed. Fifty-three patients with 54 pregnancies were studied. The mean levels of serum creatinine and eGFR in the first trimester were 138.4±76.7μmol/l and 44.9±13.5ml/min/1.73m2, respectively. The perinatal mortality rate was 1.92%. The mean gestational age at birth was 35.4weeks, and the average infant birth weight was 2333g. The average gestational week at delivery of patients with stage 3a CKD was 36.8±2.1weeks and there were no adverse neonatal outcomes. Compared with that in early pregnancy, the mean eGFR at 6months after delivery decreased (52.3±7.3 vs 44.8±10.5ml/min per 1.73m2, P<0.01) in patients with stage 3a CKD and urine protein≥1g/24h and in patients with stage 3b CKD and urine protein≥1g/24h (38.0±2.7 vs. 26.9±10.1ml/min per 1.73m2, P=0.03). The pregnancy outcomes of patients with stage 3a CKD and proteinuria<1g/24h are acceptable. Pregnancy accelerates renal function deterioration more significantly among patients with stage 3-5 CKD and urinary protein concentrations above 1g/24h.

A prospective study of living kidney donors: 6 years follow-up from a cardiovascular disease risk perspective.

SUMMARYOBJECTIVE:The purpose of this prospective study was to evaluate the clinical, laboratory, and donation-specific outcomes of living kidney donors 6 years after donation.METHODS:We included a total of 93 kidney donors and 54 age- and sex-matched individuals as control group through a type 2 cohort consecutive recruitment. We detected kidney function abnormalities and the presence of hypertension, diabetes, and cardiovascular events during the 6 years follow-up period.RESULTS:The mean serum creatinine levels were higher (p<0.001), and the estimated glomerular filtration rate levels were lower (p<0.001) in living kidney donors 6 years after donation when compared with controls. The protein/creatinine ratio of the study population was also higher (p=0.014). There was no difference in outcomes between the groups for end-stage kidney disease and cardiovascular mortality. A higher rate of new-onset hypertension (6.4 vs. 32.9%), diabetes mellitus (0.0 vs. 4.3%), chronic kidney disease (0.0 vs. 2.1%), and cardiovascular disease (0.0 vs. 2.1%) was demonstrated among donors 6 years after donation (p<0.001, respectively).CONCLUSION:Our data have demonstrated that the reduction in Glomerular filtration rate induced by kidney donation might cause an increase in adverse renal and cardiovascular events.

Micro-elimination of hepatitis C in patients with chronic kidney disease: an Egyptian single-center study

Background and aimsMicro-elimination of hepatitis C in renal patients is crucial. This study aims to assess the efficacy and safety of directly acting antivirals in chronic kidney disease patients and the effect of treatment on kidney functions.ResultsThis prospective cohort study included 77 chronic HCV-infected patients with chronic kidney disease. Patients were consented and treated for 12 weeks with either sofosbuvir and daclatasvir ± ribavirin if glomerular filtration rate was > 30 mL/min per 1.73m2 or ritonavir-boosted paritaprevir-ombitasvir-ribavirin if it was < 30 mL/min per 1.73m2. Patients were divided into two categories (responders versus non-responders). Predictors of response to treatment were statistically analyzed through logistic regression analysis. Sixty-two patients received ritonavir-boosted paritaprevir-ombitasvir-ribavirin, 3 received sofosbuvir and daclatasvir, and 12 received sofosbuvir and daclatasvir plus ribavirin. Most patients were on hemodialysis (n = 36) while 31 were stage 3 kidney disease. All patients completed their treatment course; ribavirin doses were adjusted or stopped in patients who developed anemia (40%). Seventy-two patients (93.5%) achieved sustained virological response 12 weeks following end-of-treatment. Five patients (6.5%) were non-responders, 4 of whom were on hemodialysis (p = 0.179). All non-responders were on ritonavir-boosted paritaprevir-ombitasvir-ribavirin. The mean serum creatinine level at weeks 4 and 8 of treatment demonstrated significant improvement compared to pretreatment values (p < 0.001) in patients on conservative therapy.ConclusionTreatment of chronic kidney disease patients for chronic hepatitis C with directly acting antivirals is safe, efficacious with high response rates and likely to improve renal functions if started early in the course of kidney disease.

Effects of high-activity radioactive iodine treatment on renal function in patients with differentiated thyroid carcinoma - retrospective study.

It is not clear whether high-activity radioactive iodine (¹³¹I) treatment will affect renal function. This study aimed to investigate the effects of high-activity ¹³¹I treatment on the clinical metrics of renal function in patients with differentiated thyroid carcinoma (DTC). 262 DTC patients with abnormal baseline renal function (group A) and 262 DTC patients with normal baseline renal function (group B) who received 131I therapy were analysed. Each group was further divided into three subgroups based on the cumulative activity of 131I: subgroup 1 if the cumulative activity was less than 11.1 GBq; subgroup 2 if the cumulative activity was between 11.1 GBq and 18.5 GBq; and subgroup 3 if the cumulative activity was more than 18.5 GBq. The clinical metrics of renal function including serum creatinine (SCr), blood urea nitrogen (BUN) and estimated glomerular filtration rate (eGFR) were measured and compared before initial 131I treatment and 5 years later. There was no significant difference of the demographics between the two groups. In group A, SCr and BUN levels were elevated in 186 and 113 patients, respectively, and eGFR was decreased in 108 patients before the initial ¹³¹I therapy. SCr and BUN levels were found to be increased in all subgroups 5 years after the initial ¹³¹I therapy; furthermore, eGFR was found to be decreased in all subgroups after ¹³¹I therapy, and the difference was statistically significant (p < 0.05). A gender bias was not observed in the changing trends of SCr and BUN levels and eGFR. In group B, no significant difference in the mean levels of SCr, BUN, and eGFR was observed in the 3 subgroups (p > 0.05), regardless of gender, before the initial ¹³¹I therapy and 5 years later. A total of 5, 2, and 2 patients presented with abnormal renal function after ¹³¹I treatment in subgroups 1, 2, and 3, respectively. No statistically significant difference was observed in the incidence of renal dysfunction among the 3 subgroups (p = 0.423). Our findings suggest that the nephrotoxicity of high-activity ¹³¹I therapy, regardless of gender, is very low in patients with DTC with normal renal function; however, high-activity ¹³¹I therapy may exacerbate the loss of renal function in those with renal dysfunction.

Assessment of Renal and Liver Function Tests Before and After Induction of Chemotherapy in Newly Diagnosed Acute Lymphoblastic Leukemia in Children

A prospective study was done in the Department of Paediatric Hematology &amp; Oncology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, between January and June of 2012, to observe the renal and liver function status in children suffering from acute lymphoblastic leukemia (ALL) before and after induction of chemotherapy. A total of 30 diagnosed patients of acute lymphoblastic leukemia were enrolled in the study. Renal and liver function tests were done before and after induction of chemotherapy. All the patients of the study were within 2-11 years range. Mean age was 5.12±2.53 years. Maximum 43.3% patients were within 3-6 years of age followed by 33.3% up to 3 years of age,13.3% within 6-9 year of age range and 10% above 9-year age range. 73.3% were male and 26.7% were female. Among the liver functions tests, mean bilirubin level of the patients before induction of chemotherapy was 2.31±4.71 mg/dl and after induction of chemotherapy was 1.12±2.15 mg/dl (P=0.122). Mean SGPT levels were 35.33±15.82 IU/L and 75±57.12 IU/l respectively (P=0.001). Mean total protein levels were 67.05±6.99 gm/dl and 64.47±7.51 gm/dl respectively (P=0.06). All the patients were HBsAg negative. Among the renal function tests, mean blood urea level of the respondents before induction was 28.89±7.95 mg/dl and after induction was 30.67±9.39 mg/dl (P=0.429). Mean serum uric acid levels were 4.63±1.18 mg/dl and 5.12±0.44 mg/dl respectively (P=0.044). Mean serum creatinine levels were 0.74±0.27 mg/dl and 0.67±0.22 mg/dl respectively (P=0.168). Mean GFR was 99.77±37.38 ml/1.732/min. before induction of chemotherapy and 108.57±37.29 ml/1.732/min. following chemotherapy (P=0.177). Kidney and liver functions may be affected in ALL in children. Recognition of hepatic and renal impairment at the onset of illness helps judicious chemotherapy in management of ALL.&#x0D; CBMJ 2022 January: vol. 11 no. 01 P: 21-26

The long-term impact of bloodstream infections on patient and graft survival following kidney transplantation.

There are limited data on the impact of bloodstream infections (BSI) following kidney transplantation (KT) on long term patient outcome. This was a retrospective parallel-cohort study. We included 123 consecutive KT recipients who were admitted with a first episode of BSI between January 2007 and December, 2016. They were matched with 225 KT recipients who did not have BSI. Multivariate regression analysis with BSI as time-dependent covariate was used for the effect of BSI on graft loss, all-cause mortality and long-term graft function (defined by the slope of mean serum creatinine level). During a median follow-up of 89.4 months, post-transplant BSI was independently associated with all-cause mortality (HR 5.56, 95% CI 3.07-10.09, P<.0001) and graft failure (HR-2.82, 95% CI 1.40-5.64, P=.003) after adjustment for potential confounders. This association remained irrespective of the source of infection or pathogen, but became nonsignificant when appropriate antibiotic therapy was administrated. Baseline kidney function was independently associated with graft failure. Recipients with BSI had lower baseline kidney function; however, the BSI episode had no influence on the slope of change in serum creatinine over time. BSI after KT was associated with long-term adverse outcome. This effect was mitigated by the early administration of appropriate antibiotics.