Mean Serum Creatinine Level Research Articles

O197: Quality Assessment of Human Kidneys by Ex-vivo Normothermic Machine Perfusion prior to Transplantation

Abstract Introduction Ex-vivo normothermic machine perfusion (NMP) is a technique of preservation that can be used to assess the quality and suitability of a kidney for transplantation. This may prevent the unnecessary discard and increase the number of transplanted kidneys. Methods A total of 22 kidneys declined for transplant by all UK transplant centres, were assessed over a three-year period across three centres in the UK. Prior to NMP, most kidneys were declined due to poor quality cold flushing at retrieval. All kidneys were assessed during 1h of NMP. A quality assessment score (QAS) based on the appearance, blood flow and urine output was applied to each kidney. Scores ranged from 1 (best) to 5 (worst). Results Sixteen kidneys (72%) had a QAS of 1 to 3 and were transplanted into matched recipients. One patient died with a non-functioning kidney 12 days post-transplant due to a cardiac arrest. Six recipients (37.5%) had delayed graft function. The mean serum creatinine levels and estimated glomerular filtration rate at 3 months was 154±74µmol/L and 45±15mL/min/1.73m2, respectively. Graft and patient survival at 12 months were 94%. Of the 6 non-transplanted kidneys, 3 were deemed unsuitable after assessment during NMP, 1 was not transplanted due to logistical reasons and a prolonged cold ischaemic time, and the remaining 2 due to chronic degenerative changes assessed by histology scores. Conclusion This clinical research study demonstrated the ability to use NMP technology to successfully increase the number of transplants by assessing kidneys that would otherwise be discarded.

TREATMENT WITH SILDENAFIL CITRATE IN RENAL TRANSPLANT PATIENTS WITH ERECTILE DYSFUNCTION

Erectile dysfunction (ED) is a prevalent and distressing condition among renal transplant patients, often stemming from multifactorial causes such as medication side effects, psychological factors, and vascular complications associated with end-stage renal disease (ESRD) and transplantation. The basic aim of the study is to find the treatment with sildenafil citrate in renal transplant patients with erectile dysfunction (ED). This prospective observational study was conducted at the Institute of Kidney Disease Peshawar from 2017 to 2023. A total of 240 participants were recruited using convenience sampling methods. All male patients aged 18 years or older who had undergone renal transplantation and reported persistent ED for a duration of at least six months post-transplantation. Patients who use nitrate medications, severe cardiovascular disease, and uncontrolled hypertension were excluded from the study. Data were collected from 240 patients. The mean age of the patients was 52 ± 8.01 years and the mean duration of the transplant was 5.1 ± 3.2 years. Almost 70% of patients were suffering from hypertension, 45% from DM, and 30% from CVD. The mean level of serum creatinine was 1.5 ± 0.3 mg/dl and the mean GFR was 60 ± 10mL/min/1.73m². The assessment at baseline revealed an IIEF erectile function score of 12.5, which significantly improved to 20.2 at the 12-week follow-up, indicating a notable enhancement in erectile function among participants. Moreover, the frequency of successful intercourse also exhibited a positive change, with participants reporting an increase from 1-2 times per month at baseline to 3-4 times per month at the 12-week. It is concluded that sildenafil citrate demonstrates significant efficacy in improving erectile function and sexual satisfaction among renal transplant patients with erectile dysfunction.

Reference intervals for serum creatinine and urea in the adult western Sudanese population

Introduction: Serum creatinine and urea levels are affected by numerous factors such as ethnicity, environment, age, sex, and anthropometric measurements. The Clinical and Laboratory Standards Institute (CLSI) recommends that each laboratory should establish its own reference intervals for biochemistry and haematology. There are no local reference intervals for serum creatinine and blood urea in Sudan; instead, intervals derived from worldwide research are used. The purpose of this study was to determine the blood urea and serum creatinine reference intervals for healthy adults in the Western Sudanese population.
 Method: Randomly selected adult Sudanese residents of Al Fashir City who were from the Western Sudan states of Kordofan and Darfur were the subjects of a cross-sectional study conducted in September and October 2018. We recruited 153 participants. After giving their consent, they were evaluated using a questionnaire that collected medical history and demographic information. We used standard techniques to measure blood pressure, body mass index, urea, and creatinine. Kolmogorov-Smirnov tests were used to assess the distributions of the creatinine and urea values, and reference intervals calculated. T-tests were used to investigate differences of mean creatinine and urea levels by sex and age. IBM SPSS Statistics version 25 was used to analyse the data and p ≤ 0.05 was considered significant.
 Results: Overall, the reference intervals (Mean±1.96*SD) for serum creatinine and urea levels were 0.45-0.92 mg/dL and 7.6-27.9 mg/dL respectively, compared to international reference intervals adopted from the American Board of Internal Medicine (ABIM) serum creatinine (males 0.7-1.3, females 0.5-1.1 mg/dL) and blood urea (17.12-42.8 mg/dL for both sexes) and The Western Sudanese population’s mean serum creatinine and urea levels were, respectively, 0.69 mg/dL and 17.8 mg/dL. Male sex was associated with higher levels of both creatinine and urea (p<0.001).
 Conclusion: This study documented lower reference intervals for creatinine and urea in the Western Sudanese population.

The effects of synbiotic supplementation on blood pressure and other maternal outcomes in pregnant mothers with mild preeclampsia: a triple-blinded randomized controlled trial

IntroductionPreeclampsia affects a significant percentage of pregnancies which is a leading cause of premature birth. Probiotics have the potential to affect inflammatory factors, and oxidative stress, which are linked to the development of preeclampsia. The study aimed to compare the effect of synbiotic and placebo on blood pressure and pregnancy duration as primary outcomes, and other pregnancy outcomes.MethodsThis study comprised 128 pregnant women with mild preeclampsia and gestational ages exceeding 24 weeks who were referred to the high-risk pregnancy clinic. It was a randomized, controlled, phase III, triple-blinded clinical experiment. The intervention and control groups were distributed to the participants at random. Intervention group received one oral synbiotic capsule, and control group received placebo daily until delivery. Based on gestational age at the time of diagnosis, preeclampsia was stratificated as early (< 34 weeks) or late (≥ 34 weeks). Data obtained from questionnaires, and biochemical serum factors were analyzed using SPSS software version 23 software.ResultsWith the exception of the history of taking vitamin D3, there were no statistically significant variations in socio-demographic variables between the research groups. After the intervention, the means of systolic blood pressure (adjusted mean difference: -13.54, 95% CI: -5.01 to -22.07), and diastolic blood pressure (adjusted mean difference: -10.30, 95% CI: -4.70 to -15.90) were significantly lower in the synbiotic-supplemented group than in the placebo group. Compared to the placebo group, the incidence of severe PE (p < 0.001), proteinuria (p = 0.044), and mean serum creatinine level (p = 0.005) significantly declined in the synbiotic-supplemented group after the intervention. However, our analysis found no significant association for other outcomes.ConclusionBased on our results, synbiotic had beneficial effects on some pregnancy outcomes. Further studies with larger samples are needed to verify the advantages of synbiotic supplementation for high-risk pregnancies, particularly with regards to higher doses, and longer intervention periods.Trial registrationIRCT20110606006709N20.

Eliminating the need for preoperative intravenous hyperhydration: Sodium thiosulfate as nephrotoxicity prevention in HIPEC-treated patients – A retrospective analysis

BackgroundCytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment for peritoneal metastases. However, HIPEC with cisplatin is associated with renal toxicity. Sodium thiosulfate (ST) has been shown to prevent cisplatin-induced toxicity. MethodsA retrospective, single-center analysis of patients treated curatively for peritoneal surface malignancy, who underwent cytoreductive surgery with cisplatin-based HIPEC between 2015 and 2020. Patients were categorized into three groups based on the management of cisplatin-induced renal toxicity: preoperative hyperhydration alone (PHH), preoperative hyperhydration with ST (PHH + ST), and ST alone. Renal function and complications, in terms of Acute (AKI) and chronic kidney injury (CKI), were monitored and analyzed during 3 postoperative months. ResultsThis study included 220 consecutive patients. Mean serum creatinine levels were 95, 57 and 61 mmol/L, for PHH, PHH + ST and ST groups, respectively (p < 0.001). Glomerular Filtration Rate (GFR) were 96, 94 and 78 ml/min/1.73 m2, respectively (p < 0.001). AKI and CKI are respectively for PHH, PHH + ST and ST groups were 21 % (n = 46), 1 % (n = 2) and 0 % vs 19 % (n = 42), 0 % and 0 % (p < 0.001), for pairwise analysis did not show any difference between PHH + ST and ST alone combination, regarding nephrological outcomes. All patients were followed 3 months postoperatively. ConclusionThere is no need for preoperative hyperhydration when sodium-thiosulfate is used to prevent cisplatin-induced nephrotoxicity in patients undergoing cytoreductive surgery with HIPEC. These findings have implications for improving and simplifying the management of patients with peritoneal metastases undergoing HIPEC with cisplatin.

Serum Uric Acid to Creatinine Ratio with Estimated Glomerular Filtration Rate in Type 2 Diabetes Patients.

Diabetes mellitus is a metabolic disorder associated with cardiovascular and renal complications. The serum uric acid to creatinine ratio and estimated glomerular filtration rate are important markers used to assess kidney function in patients with type 2 diabetes. This study aimed to find the correlation between serum uric acid to creatinine ratio and estimated glomerular filtration rate to various parameters among the diabetes patients. It is an observational hospital-based, cross-sectional study. Patients with a diagnosis of diabetes for three years or more duration were selected. This study designed to serum uric acid to creatinine ratio with estimated glomerular filtration rate and its relationship with other biochemical parameters. The Modification of Diet in Renal Disease formula was used to calculate estimated glomerular filtration rate (eGFR). eGFR (mL/min∙1.73 m2) = 186 × (Scr) -1.154 × (age) - 0.203 × (0.742 female). Low eGFR was defined as eGFR<60 mL/min∙1.73 m2. The data were analyzed by SPSS version 20. Mean values of different variables, standard deviations and p-values were calculated. Mean serum uric acid to creatinine ratio was 6.09±1.71 and elevated among 49.1%. Mean blood urea and serum creatinine levels were 28.0±10.72 and 1.01±0.18, respectively. There was a significant positive correlation between eGFR and serum uric acid : serum creatinine ( r = 0.246, p = 0.007) in this study. The serum uric acid to creatinine ratio can serve as an early marker for renal injury, showing a positive correlation with estimated glomerular filtration rate (eGFR). Monitoring serum uric acid to creatinine ratio levels alongside eGFR can assistance in the identification and management of kidney damage in its early stages.

Frequency of acute kidney injury in birth asphyxia at a Tertiary Care Hospital, Karachi.

ABSTRACT… Objective: To determine the frequency of acute kidney injury (AKI) in neonates presenting with birth asphyxia. Study Design: Cross-sectional study. Setting: Department of Pediatrics, National Institute of Child Health, Karachi. Period: December 2022 to May 2023. Material &amp; Methods: A total of 159 neonates of both gender, aged between 7-28 days and having birth asphyxia were analyzed. Demographic features were recorded. The blood sample was collected in a sterile manner using 5 ml syringe and sent to the institutional laboratory for serum creatinine and electrolyte analysis. The frequency of AKI was noted. Results: In a total of 159 neonates, 95 (59.1%) were boys, The mean baseline serum urea and creatinine were 33.5±32.1 and 0.83±0.62 mg/dl respectively. AKI was noted in 65 (40.9%) neonates. Girls (p=0.035), relatively lower occipital frontal circumference (p=0.004), normal vaginal delivery (p&lt;0.001), history of seizures (p&lt;0.001), abnormal USG KUB (p&lt;0.001), poor conscious level (p&lt;0.001), higher birth asphyxia grading (p&lt;0.001) and poor urine output (p&lt;0.001) were linked with AKI. Mean baseline serum urea levels and serum creatinine levels were significantly raised among neonates who had AKI. Conclusion: The frequency of acute kidney injury among neonates having perinatal asphyxia was high. AKI was noted to have significant association with female gender, relatively lower occipital frontal circumference, normal vaginal delivery, history of seizures, abnormal ultrasonography findings, poor conscious level, higher birth asphyxia grading, and poor urine output at the time of admission.

Kidney transplant to vesicostomy: A safe strategy for children with end stage renal disease and lower urinary tract anomalies

Resolution of underlying urinary tract anomalies prior to kidney transplantation in patients with end stage renal disease (ESRD) secondary to uropathy, has been historically supported under the argument that this would help prevent infectious complications and graft loss. We propose to perform earlier kidney transplantation with a transient vesicostomy, deferring resolution of the uropathy to the post-transplantation period. The aim of this study was to evaluate the outcomes of kidney transplantation in children with a vesicostomy. A retrospective, multicenter study was performed including all patients under 18 years of age who underwent kidney transplantation with a vesicostomy, between January 2005 and December 2020 and had at least one year of follow up. Data related with the indication and timing of vesicostomy, time until transplantation, post-transplantation complications, urinary tract infections (UTI) and graft survival rate were collected. Of the 758 transplantations performed in the study period, 16 patients met the inclusion criteria. Mean age at transplantation was 58 months (range 20-151), and mean weight was 13.5Kg (range 8.4-20). Mean time from vesicostomy to kidney transplantation was 30 months (range 0-70). There were 2 (12.5%) ureteral complications that required reoperation. Eighteen episodes of UTI were identified in 8 patients (50%), accounting for 0.4 UTIs per patient-year of follow-up. UTIs did not lead to graft loss in any of the cases. Urinary tract reconstruction was performed in 5 patients (31.3%) at an interval of 1-91 months post-transplantation. After a mean follow-up of 44.8 months (range 13-200) from transplantation, patients with vesicostomy had a mean creatinine clearance of 86.6ml/min/1.73m2, with a mean serum creatinine level of 0.6mg/dl. Graft survival rate was 100%. Early kidney transplantation into a vesicostomy permits a resolution of the ESRD, avoiding deleterious effects related to dialysis. With a low rate of UTIs, we found no graft loss due to infectious complications. This strategy permits careful planning and better timing for the urinary tract reconstruction without delaying kidney transplantation. Kidney transplantation in pediatric patients with vesicostomy seems to be a safe and effective strategy. UTI rate was similar to that reported in the literature of patients with corrected urinary anomalies undergoing kidney transplantation without urinary diversion.

The Effect of Oral N-Acetyl Cysteine Administration on Acute Kidney Injury Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Background: Acute kidney injury (AKI) is a clinical condition characterized by a rapid decline in kidney function that includes structural damage (injury) or malfunction (impairment). AKI is a common complication that occurs in 5-10% of patients due to various underlying etiologies. One of the underlying pathophysiology of AKI is the role of discharge reactive oxygen species (ROS), which causes injury to kidney cells. From various studies, it has been reported that N-acetylcysteine (NAC) has anti-inflammatory and antioxidant effects and has an effect on reducing serum creatinine values.&#x0D; Methods: This research is an open randomized clinical trial without control involving 30 patients at Dr. Mohammad Hoesin General Hospital, Palembang, who were all given intervention in the form of NAC 1200 mg/day, starting in September – October 2023. This study aimed to determine the role of NAC in reducing serum creatinine values in patients with acute kidney injury at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia. Data analysis was carried out using SPSS 21 univariate and bivariate.&#x0D; Results: From the research results, it was found that the average age of patients was 53.9 years, involving 21 males (70%, N=30) and 9 females (30%, N=30). The most common causes were prerenal and then renal (53.3% and 46.7%). The initial serum creatinine level was found to be 2.12± 0.79 mg/dL (n = 30 samples), and after administration of the intervention, the mean serum creatinine level was 1.28± 0.63 mg/dL (n = 30 samples). By using a paired t-test, there was a decrease in serum creatinine levels significant (p=0,012).&#x0D; Conclusion: NAC administration to patients with acute kidney injury of pre-renal or post-renal causes has a statistical effect on reducing serum creatinine values in patients with acute kidney injury at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia.

Clinical value of arterial stiffness assessment on risk prediction of vascular stiffness in the octogenarian elderly

Objective: This study aimed to analyze clinical factors related to arterial stiffening and establish a risk prediction nomogram of arterial stiffening in the octogenarian(≥80 years). Methods: This study was a retrospective cross-sectional study, which enrolled the octogenarian elderly who underwent physical examination and secondary prevention intervention in the outpatient department of Chinese People's Liberation Army General Hospital from April 2022 to August 2022. Clinical data including demographics, biochemical indicators and medical history were collected. Brachial-ankle pulse wave velocity (baPWV) was detected during the clinical visit. Participants were divided into the control group (baPWV≤1 800 cm/s) and vascular sclerosis group (baPWV>1 800 cm/s). The risk factors of arterial stiffness were analyzed by univariate and logistic regression analysis, and the nomogram model was constructed by R programming language. The predictive effect of the nomogram model was evaluated by the receiver operating characteristic curve (ROC). Results: The median age of the 525 participants was 87.0 (82.0, 92.0) years, 504 (96.0%) were male, 82 in the control group, 443 in the vascular sclerosis group. The baPWV, age, systolic blood pressure, mean arterial pressure and diastolic blood pressure were significantly lower in the control group than those in the vascular sclerosis group (all P<0.05). Logistic regression analysis showed that high-density lipoprotein cholesterol, alanine aminotransferase and amylase were protective factors, and alkaline phosphatase and creatinine were risk factors of arterial stiffening (all P<0.05). The combined nomogram model scores including age, mean arterial pressure and the above five laboratory indicators indicated that mean arterial pressure and serum creatinine levels were strongly correlated with vascular sclerosis. The ROC curve suggested that the nomogram model had good prediction ability. Conclusions: Age, mean arterial pressure, high-density lipoprotein cholesterol, alanine aminotransferase, alkaline phosphatase, amylase and creatinine are independently determinants for increased vascular stiffness. The combined prediction model in this study can provide reference for individualized clinical risk prediction of vascular sclerosis in the octogenarian elderly.

COVID-19 associated mucormycosis (CAM) in Kashan, Iran: clinical presentations, risk factors, management, and outcomes

Background This study aimed to estimate the disease burden and describe the clinical presentation, risk factors, and outcome of CAM in a single centre in Iran. Methods A case of mucormycosis was defined as one that had clinical and radiological features consistent with mucormycosis along with demonstration of the fungus in tissue via KOH mount/culture/histopathological and molecular examination. Results We report 30 cases of COVID-19 associated mucormycosis (CAM). The results of this study showed the affected age group in the range of 40–79 years (median = 65.5; IQR = 5) with women (16/30, 53%) affected more than men (14/30, 47%). Among the fungi recovered, Rhizopus oryzae had the highest frequency (79%). Out of the 30 patients, 28 (93%) patients were diabetic with 24 (80%) patients having other co-morbidities. Headache followed by retro-orbital pain, proptosis/ptosis and rapid diminution of vision was a common sequence of symptoms reported by the majority of cases. Use of mechanical ventilation (58% vs. 6%, p = 0.003), O2 required (92% vs. 50%, p = 0.024), and development of renal dysfunction during hospital stay (17% vs. 0%, p = 0.041) was significantly higher in non-survivors than survivors. Temperature (C°), PR (pulse rate), mean levels of serum creatinine, BUN, troponin, and neutrophils were significantly higher in non-survivors (p < 0.05). Besides, Albumin and PO2 were also significantly higher in survivors than non-survivors. Conclusion Despite medical and surgical treatment, the mortality rate among CAM patients is still high. Thus, concerted efforts of revamping surveillance, diagnosis and management, along with public awareness and patient education, are the requisites for managing COVID-19 and mucormycosis.

Recurrent atypical antiglomerular basement membrane nephritis in the kidney transplant

Atypical antiglomerular basement membrane (anti-GBM) nephritis can be defined as linear GBM staining for monotypic or polytypic immunoglobulin (Ig) by immunofluorescence (IF) without a diffuse crescentic pattern. We describe the clinicopathologic features of 6 patients (18 biopsies) in this first series of recurrent atypical anti-GBM nephritis after kidney transplantation. Recurrent glomerulonephritis occurred at a mean of 3.8 months posttransplant (range 1-7 months). Three index biopsies were for clinical indication, and 3 were protocol biopsies. Glomerular histologic changes were mild, with 2 showing segmental endocapillary hypercellularity, 1 focal glomerular microangiopathy, and the others no significant glomerular histologic changes. All 6 allografts showed monotypic linear glomerular Ig staining by IF: IgG kappa (n = 2), IgG lambda, IgA kappa, IgA lambda, and IgM lambda. Follow-up biopsies were available for 5 patients and showed similar histologic and IF findings without evidence of significant progression. No patients had detectable serum anti-GBM antibody or monoclonal proteins. The mean serum creatinine level on follow-up (24-62 months posttransplant) was 1.8 (range 0.93-2.77) mg/dL; no grafts were lost to recurrent disease. This series demonstrates that monotypic atypical anti-GBM recurs in the allograft and supports the idea that this disease is due to a circulating monoclonal protein.

Correlation between Serum High-Sensitivity C-Reactive Protein Level and Severity of Albuminuria Measured by Urine Albumin-to-Creatinine Ratio in Type 2 Diabetic Patients

Introduction: One of complications in type 2 diabetes mellitus (DM) that require high treatment cost is diabetic kidney disease (DKD), which is characterized by the presence of albuminuria, decrease in glomerular filtration rate, or both. Researches show a positive correlation between type 2 DM and serum high-sensitivity C-reactive protein (hs-CRP) level, a sensitive marker of subclinical inflammation. This study aimed to analyze the correlation between serum hs-CRP level and severity of albuminuria measured by urine albumin-to-creatinine ratio (ACR).Methods: The study was conducted at the Endocrinology Outpatient Clinic of Dr. Soetomo General Academic Hospital, Surabaya, on June-July 2020.Results: The study included 50 patients with type 2 DM, consisting of 25 (50%) men and 25 (50%) women, with median age of 58.0 (42-68) years and mean body mass index (BMI) of 21.91 ± 1.310 kg/m2. Median duration of DM was 12.0 (6-22) years, median HbA1c level was 7.20% (5.7%-12.3%), mean serum crEatinine level was 0.83 ± 0.180 mg/dL, and median estimated glomerular filtration rate (eGFR) value was 92.85 (61.6-121.2) mL/minute/1.73 m2. Median serum hs-CRP level was 1.20 (0.1-4.0) mg/L and median urine ACR value was 49.570 (7.78-426.00) mg/g. Normoalbuminuria was detected in 28% of subjects, microalbuminuria in 66% of subjects, and macroalbuminuria in 6% of subjects. This study showed positive and significant correlation between serum hs-CRP level and severity of albuminuria (r = 0.701; p = &lt;0.001).Conclusion: There was positive and significant correlation betweeen serum hs-CRP level and severity of albuminuria in type 2 diabetic patients.

Hemodialysis: The Life Boat for AKI Patients in the COVID Cytokine Storm.

Interleukin-6 (IL-6), a biomarker of hyperinflammatory immune response, can be used to determine the severity of coronavirus disease 2019 (COVID-19) in patients with multi-organ involvement requiring critical care. The aim of our study is to understand the utility of hemodialysis, not only in terms of reducing renal burden, but also improving the outcome by tackling the COVID cytokine storm syndrome. In this prospective, observational study, 126 patients admitted to the COVID intensive care unit (ICU) wards were treated with hemodialysis for acute kidney injury (AKI). Patients' routine baseline blood parameters were evaluated. IL-6 was measured predialysis in all patients and on the day of discharge in the patients who survived. Out of total 126 patients, 79 were survivors and 47 were nonsurvivors. Among nonsurvivors, majority were older (P = 0.009). Both the groups had a higher percentage of males (78.72% and 55.69% in survivors and nonsurvivors, respectively). Mean neutrophil lymphocyte ratio (NLR) and D-dimer level were significantly higher in nonsurvivors compared to survivors (P < 0.001). Mean serum urea, creatinine, and IL-6 levels were significantly greater in nonsurvivors (P < 0.001). Mean number of hemodialysis sessions received by survivors was higher. The curve between delta IL-6 and delta serum creatinine for survivors showed a significant positive association (r = 0.819, P < 0.001). Our study establishes IL-6 as a poor outcome predictor in COVID ICU patients with AKI. It also emphasizes the use of hemodialysis as a cost-effective lifesaving therapeutic interventional modality to not only improve the renal outcome, but also curb the cytokine storm by reducing IL-6 levels.

#4043 FABRY DISEASE: A RARE ENTITY IN THE NEPHROLOGY SETTING

Abstract Background and Aims Fabry disease is a rare genetic disorder that affects multiple organs, including the kidneys. It is characterized by the accumulation of globotriaosylceramide (Gb3) in various tissues and organs, leading to progressive interstitial fibrosis and renal dysfunction. We aim to determine the renal manifestations of Fabry disease in particular the histological aspects. Method This study analyzed 9 patients with Fabry disease and renal involvement in a retrospective, single-center analysis. Clinical and biological data, as well as histologic findings, were collected based on patient's observations. Results Data was collected from 9 patients, including 7 males and 2 females, with an average age at diagnosis of 25.2 years (ranging from 17 to 32 years). All patients showed depleted activity of alpha 1 glycosidase, confirming the diagnosis. Acrosyndrome and vascular cutaneous lesions (angiokeratomas) were the dominant signs at admission with respectively (n=7; n=4), with only 3 patients being identified through familial screening without symptoms. Uncontrolled Hypertension was noted in 2 patients. Renal manifestations included renal hyperfiltration in 2 cases, isolated proteinuria in 4 patients, and renal failure in 3 others with a mean serum creatinine levels of 240 ± 36 µmol/l. Four patients underwent renal biopsy, which showed characteristic lesions of Fabry disease with sphingolipid accumulation and tubular cell vacuolization. Thickening of the glomerular capillary walls was observed in one patient. Interstitial fibrosis and tubular atrophy were noted in 3 patients. All patients received enzyme replacement therapy. Angiotensin-converting enzyme inhibitors (ACEi) and/or angiotensin II receptors blockers (ARB) were uses in 6 patients. Five patients progressed to terminal stage of renal failure requiring dialysis after an average follow-up period of 13±2.7 years. Four patients died from cardiovascular complications. Conclusion Early recognition and diagnosis of Fabry disease from the onset of glomerular hyperfiltration and albuminuria are crucial for the initiation of appropriate treatment and management, which can help to delay the progression of renal and other organ damage.

STUDY OF THYROID PROFILE, URIC ACID, CREATININE AND LIPID PROFILE IN PRE-ECLAMPSIA PATIENT

Objectives: (1) To evaluate and compare the thyroid profile and lipid profile in preeclampsia in a normotensive pregnant female in the third trimester of pregnancy. (2) To estimate and compare serum uric acid and serum creatinine in preeclampsia in normotensive pregnant females. Methods: In the present study, 154 patients, of which 79 preeclampsia (cases) and 75 (controls), were selected randomly and matched with their gestational age in patients who attended an ANC clinic at the Department of Obstetrics and Gynecology, NSCB Medical College, Jabalpur, from March 2016 to August 2017. All patients were evaluated for their lipid profile, thyroid profile, serum uric acid, and serum creatinine. The study includes patient’s specific detailed clinical history, physical examination findings, and a report of relevant investigations recorded from the patient who presented with pre-eclampsia and normotensive pregnant female attending the ANC Clinic of N.S.C.B. Medical College, Jabalpur. Results: The most common age group for preeclampsia was 20–24 years. Preeclampsia was most common in the nullipara as compared to the multipara. Pre-eclampsia cases commonly occur in low-socioeconomic and rural areas. In this study, pre-eclamptic women showed higher serum concentrations of total cholesterol (221.60±22.55), low density lipoprotein (LDL) (134.44±16.96), Very LDL (48.48±6.88) and Triglyceride (243.50±32.33) when compared to normotensive women, which was statistically significant. In this study, a statistically significant decrease in HDLC (34.55±5.37) was observed in pre-eclamptic women. An increase in serum creatinine was observed in women with pre-eclampsia. The mean serum creatinine level was (1.21±0.47). Conclusion: Our study concludes that nulliparous and low-socio-economic women had a higher risk of pre-eclampsia. Maternal age between 20 and 24 years are more prone to develop pre-eclampsia. Serum uric acid levels are significantly higher in pre-eclampsia patients and could be a useful indicator of maternal and fetal complications in hypertensive patients.

Kidney Transplant Outcomes in Patients with Atypical Hemolytic Uremic Syndrome

Atypical hemolytic uremic syndrome (aHUS) is a rare disorder with a high probability of recurrence after a kidney transplant and can adversely affect the graft outcome. Our objective was to assess the transplant outcome of patients with aHUS who had undergone a kidney transplant. We retrospectively included patients who had undergone a kidney transplant and been diagnosed with aHUS based on an anti-complement factor H (AFH) antibody level >100 AU/mL and the presence of a genetic abnormality in complement factor H (CHF) or CHF-related (CFHR) genes. Data were analyzed with descriptive statistics. Among 47 patients with AFH antibody levels >100 AU/mL, 5 (10.6%) had undergone a kidney transplant. The mean age was 24.2 years, and all were male. Atypical hemolytic uremic syndrome was diagnosed before transplant in 4 (80.0%) cases, whereas 1 was diagnosed after transplant owing to disease recurrence in the transplanted graft. Genetic analysis of all cases revealed one or more abnormalities in CFH and CFHR genes 1 and 3. With an average of 5 sessions of plasma exchange and the use of rituximab in 4 cases, there was a reduction in the disease severity with no recurrences in the post-transplant period. At the latest follow-up of 223 days, the mean serum creatinine level was 1.89 mg/dL, indicating good graft function. Among patients diagnosed with aHUS, the use of pre-transplant plasma exchange and rituximab can be beneficial in terms of preventing graft dysfunction and reducing disease recurrence in the post-transplant period.

Clinico-Pathological Outcomes of Patients With Crescentic Glomerulonephritis: A Single-Center Study.

Background Crescentic glomerulonephritis (CrGN) is a pathological description of rapidly progressive glomerulonephritis (RPGN). It is characterized by renal failure and is associated with a grave prognosis. This study aimed to investigate the clinical outcomes of patients diagnosed with crescentic glomerulonephritis at the King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Method This retrospective study included patients with CrGN who underwent treatment at the nephrology department at KAUH from June 2021 to August 2022. We collected and analyzed data from 56 patients diagnosed with CrGN on the basis of renal biopsies between 2002 and 2015. Result The study included 17 cases of CrGN. The mean age of patients at the time of diagnosis was 18.06 ± 13.49 years. The distribution of histological findings showed that cellular crescents (94.1%) and interstitial fibrosis and tubular atrophy (IFTA) (76.5%) were the most commonly observed histological findings. The most common underlying etiology was lupus nephritis (41.2%). Regarding the lab results, the mean serum creatinine level at admission was 378.88 ± 273.27 μmol/L, proteinuria was 1.53 ± 1.23 and glomerular filtration rate (GFR) level was 36.94 ± 45.08 mL/min. The factors associated with poor renal outcome were IFTA(P=0.01), phosphate level before discharge, serum creatinine level before and after discharge (P=0.032), and GFR level after discharge (P=0.001). Conclusion Crescentic glomerulonephritis is an important cause of acute kidney injury due to its potential to result in severe glomerular injury. In our study, 12 out of 17 patients experienced poor renal outcomes, which were associated with a high risk of morbidity and mortality. Therefore, early detection and treatment of CrGN is crucial in order to manage the disease.

Thyroid Dysfunction and Chronic Kidney Disease: A Study Among the Northeastern Population of India.

Chronic kidney disease (CKD) is a multifaceted non-communicable disease characterized by a progressive decline in kidney function ultimately requiring renal replacement therapy (RRT) in most patients. Due to the high cost and availability of a limited number of donors, the majority of patients dependon dialysis and conservative management. Thyroid hormones are indispensable for the growth, development, and homeostasis of our body. The kidney plays an important role in the metabolism, degradation, and excretion of thyroid hormones. Various studies have revealed significant dysfunction in thyroid hormone status in CKD patients, but the results are inconsistent. To evaluate and compare the thyroid hormone status in CKD patients with healthy controls along with a comparison of thyroid hormones in CKD patients on regular hemodialysis with those on conservative management. The present cross-sectional study involved 100 subjectsof both sexes between 40 and 70 years of age, out of which 50 were patients of stage 5 CKDwith no previous history of any thyroid disorders, while 50 apparently healthy subjects served as control. Of the CKD patients,52% were on regular hemodialysis while 48% were receiving conservative care. The participants were investigated for various biochemical parameters like blood urea, serum creatinine, total triiodothyronine (TT3), total thyroxine (TT4), and thyroid stimulating hormone (TSH). The estimated glomerular filtration rate (eGFR) was calculated using a modification of diet in renal disease (MDRD) 4 variable formula. The thyroid profiles were also compared between patients of CKD receiving conservative management and those on maintenance hemodialysis. Of the total sample, 35 (70%) were male and 15 (30%) were female in each of the case and control groups. The mean ageof CKD patients and the control group was 55.32 ± 9.62 years and 54.48 ± 9.63 years, respectively. TT3 was reduced in all50 CKD patients. TT4 was normal in 31 (62%), reduced in 18 (36%), and high in one (2%) case. TSH was high in 38 (76%) cases, while reduced in one (2%) and normal in 11 (22%) cases. The mean blood level of TT3 and TT4 showed a statistically significant reduction (P < 0.0001 for each), while the TSH level showed a significant increase with a p-value of 0.0002 in CKD patients compared to controls. The mean blood urea and serum creatinine levels were statistically increased in cases than in controls (P < 0.0001). The thyroid hormone status revealed a significant difference between CKD patients on maintenance hemodialysis compared to those on conservative care with a p-value of 0.0005 for TT3, 0.0006 for TT4, and 0.0055 for TSH. Patients with CKD were at risk of thyroid hypofunction irrespective of their mode of treatment. This study highlights the clinically relevant interactions between renal and thyroid function, which may be helpful to clinicians for optimal diagnosis and management of CKD patients.

HAEMODIALYSIS: A KING OR A CLOWN FOR COVID POSITIVE PATIENTS WITH PRE-EXISTING PULMONARY DISEASES!

Background: COVID-19 infection in patients with pre-existing respiratory diseases, manifesting as ARDS, while simultaneously affecting multiple organs severely worsened the outcome, raising the need to explore various treatment modalities. To study the impact of haemodialysis on outcomes of COVID-19 pati Objective: ents with pre-existing pulmonary diseases. Methods: Data of patients with known pulmonary comorbities admitted to COVID wards, undergoing haemodialysis for AKI at tertiary care centre, was collected from July 2020 to January 2022. The demographics, baseline parameters and outcomes were recorded. Total 61 Results: patients were included in this retrospective observational study. The percentage of different pre-existing pulmonary pathologies (COPD, Asthma, ILD, and Pulmonary Tuberculosis) were equally distributed among survivors(n=47) and non-survivors(n=14). The non-survivors were older(p=0.003), and had a higher percentage of males (p=0.02), higher percentage of smokers (p=0.02) and alcohol consumers(p=0.011), a lower mean systolic blood pressure, higher pulse rate, higher respiratory rate and lower SpO2. The non-survivors had a lower mean hemoglobin, platelet count, and a higher mean TLC, NLR, and D-dimer levels. On admission, the non-survivors had a higher mean blood urea level and serum creatinine level (p&lt;0.001). The number of hemodialysis done was signicantly higher(p=0.041) in the survivors as compared to non-survivors. Conclusion: Our study strongly suggests that haemodialysis can be used as a life saving treatment modality for AKI in COVID positive patients with pre-existing pulmonary disease. Also protocols need to be redened for early initiation and increased frequency of haemodialysis in patients with acute on chronic multisystem insult.